Assistant Vice President - Cost Containment, Employer Stop-Loss

The Assistant Vice President, Cost Containment is a strategic and operational leader responsible for driving cost-containment outcomes across Skyward’s employer stop-loss and captive business. This role owns the day-to-day execution of the cost-containment program — including savings delivery, vendor coordination, emerging-trend response, and ongoing program needs — while partnering with the VP on vendor selection decisions, and broader strategic direction.

The AVP serves as a senior clinical and cost-containment resource for Underwriting, Claims, and external stakeholders (TPAs, producers, policyholders, and vendors). The role requires deep expertise in cost containment within a broker, stop-loss, or reinsurance environment, with a proven ability to build scalable processes, manage complex vendor relationships, and translate clinical and financial data into actionable strategies that protect the book of business.

This position may assume direct oversight of Clinical Consultants as the team and program evolve, and should be prepared to step into that responsibility when the business need arises.

Cost Containment Strategy & Execution

• Own the day-to-day execution of Skyward's cost-containment program across the stop-loss portfolio, ensuring strategies are consistently applied and delivering measurable savings.

• Develop and refine cost-containment protocols, standard operating procedures (SOPs), and playbooks for high-cost and catastrophic claim scenarios (e.g., transplant, oncology, NICU, gene/cell therapy, high-cost pharmacy).

• Monitor and evaluate cost-containment vendor performance; manage ongoing vendor relationships and coordinate vendor engagement on active cases. Assist the VP with vendor selection, due diligence, and contract evaluation.

• Track, quantify, and report cost-containment savings; develop dashboards and regular reporting to communicate program performance to leadership.

• Stay current on emerging cost drivers, treatment modalities, regulatory changes, and market trends (e.g., biosimilars, site-of-care optimization, reference-based pricing); assess implications for the stop-loss book and recommend program adjustments.

• Identify ongoing program needs — gaps in vendor coverage, underserved claim categories, process inefficiencies — and develop recommendations to address them.

• Partner with Underwriting and Claims leadership to ensure cost-containment insights are integrated into pricing, reserving, and claim-adjudication decisions.

Clinical Risk Management & Complex Claim Oversight

• Provide senior-level clinical expertise on the most complex, high-cost, and sensitive claims; serve as an escalation point for clinical questions and cost-containment strategy on active cases.

• Oversee the clinical review process for catastrophic and high-cost claims — ensuring timely identification, appropriate vendor engagement, and effective mitigation strategies.

• Evaluate treatment plans, medical necessity determinations, and charges for clinical and financial reasonableness; coordinate specialty or independent medical review when appropriate.

• Interpret stop-loss agreements, cost-containment agreements, transplant contracts, and related contractual provisions as they apply to claim management and vendor engagement.

Stakeholder & Relationship Management

• Build and maintain executive-level relationships with TPAs, producers, policyholders, and cost-containment vendors; represent Skyward as a knowledgeable and trusted clinical partner.

• Serve as a senior point of contact for brokers and producers on cost-containment capabilities, program value, and complex claim scenarios — supporting retention and new business efforts.

• Communicate cost-containment strategies, clinical insights, and case outcomes to internal and external stakeholders with clarity and appropriate clinical justification.

• Partner with the VP on client-facing presentations, market-facing materials, and strategic discussions that position Skyward's cost-containment program as a competitive differentiator.

• Educate internal teams (Underwriting, Claims, leadership) and external parties on clinical risk drivers, cost-containment best practices, and emerging trends.

Team Leadership & Development

• Serve as a senior mentor and resource to Clinical Consultants — guiding clinical judgment, cost-containment approach, and professional development through coaching, case review, and knowledge sharing.

• May assume direct supervisory responsibility for Clinical Consultants as the team and program evolve, including performance management, workload allocation, hiring, and development planning.

• Lead or contribute to clinical education sessions (internal and external) that reinforce Skyward's market position as a knowledgeable leader in clinical risk management.

• Champion a culture of continuous improvement, accountability, and clinical excellence within the cost-containment function.

Operational Excellence & Continuous Improvement

• Design and maintain SOPs, workflows, and documentation standards for cost-containment activities, ensuring consistency, auditability, and compliance.

• Ensure all cost-containment work is documented in the ESL system in alignment with established standards.

• Develop and refine metrics and KPIs that measure cost-containment effectiveness, vendor ROI, and team performance; report regularly to leadership.

• Identify opportunities to leverage data and analytics to improve case identification, intervention timing, and savings capture.

• Stay current on industry best practices, regulatory requirements, and competitive positioning through formal and informal professional development.

• Monitor emerging technologies and vendor offerings through conferences, expos, and industry events (ex. Fall SIIA conference since it has the vendor Expo and Price Transparency conference

Qualifications, Education & Experience

The following qualifications represent the knowledge, skills, and abilities expected. Equivalent combinations of education and experience may be considered.

Required

• Minimum 10 years of progressive experience in cost containment, clinical risk management, or managed care within a broker, stop-loss, reinsurance, or carrier environment.

• Demonstrated expertise in stop-loss or reinsurance cost-containment program design, vendor management, and savings delivery.

• Management or leadership experience — formal supervisory responsibility, team leadership, or demonstrated ability to lead through influence in a matrixed environment.

• Deep knowledge of cost-containment vendors, strategies, and market landscape (e.g., transplant networks, specialty pharmacy management, case management, dialysis, reference-based pricing, independent review).

• Strong understanding of employer stop-loss contracts, claim adjudication, and the TPA/broker/policyholder ecosystem.

• Proven ability to build and maintain relationships with brokers, TPAs, and vendors at a senior level.

• Bachelor's degree or commensurate professional experience.

• Collaborate effectively with teammates and cross-functional partners to achieve shared goals.

• Communicates clearly and respectfully with colleagues, stakeholders, and leadership

• Able to give and receive feedback constructively and adapt in a collaborative environment.

• Develops strategy and recommendations by synthesizing multiple factors (data, risk, stakeholder needs, market conditions), even when a defined process does not exist.

Preferred

• Active RN license and/or clinical background (case management, ICU, NICU, oncology, transplant).

• Certified Case Manager (CCM) or other relevant professional certification.

• Experience in a broker or intermediary setting with direct exposure to the producer/client relationship.

• Track record of building or scaling a cost-containment function — including program design, vendor ecosystem development, and performance measurement.

• Strong analytical and financial skills; proficiency with Excel, data visualization, and reporting tools.

• Excellent written and oral communication skills, including the ability to present complex clinical and financial information to executive and non-clinical audiences.

Compensation & Benefits

The applicable base salary for this opportunity is $110,000 - $160,000. The base pay offered will be determined by factors such as experience, skills, training, location, certifications, education, and any applicable minimum wage requirements. In addition to the base salary, this opportunity may be eligible for performance-based incentives.​  We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition and professional certification assistance, 401k savings, elective participation in the Employee Stock Purchase Program, paid time off, paid holidays, and child bonding leave, as well as other employee assistance.

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