Director - Health and Benefits

Overview

The Director, Health & Benefits (H&B) is a senior client leader responsible for setting benefits strategy, overseeing complex delivery, and expanding executive‑level relationships across a portfolio of mid‑ to large‑market employers. This role integrates actuarial, clinical, vendor, pharmacy, and compliance perspectives to deliver measurable cost, quality, and member experience outcomes. The Director mentors consulting teams, ensures methodological rigor, and partners with firm leadership to drive revenue growth and thought leadership.

Key Responsibilities

Client Leadership & Strategy

• Serve as executive sponsor and strategic advisor for marquee client relationships; lead annual and multi‑year benefits strategy (cost containment, member experience, health equity, total rewards alignment).
• Translate analytics into executive‑level recommendations on funding, plan design, vendor mix, and risk mitigation (e.g., stop‑loss, carve‑outs, specialty/GLP‑1 management).
• Lead stewardship meetings, governance forums, and board/C‑suite presentations.

Plan Design, Funding & Analytics

• Direct evaluation of funding strategies (fully insured, level‑funded, self‑insured), stop‑loss optimization, and alternative payment/value‑based models.
• Oversee financial modeling: renewals, trend decomposition, IBNR, reserve/settlement analyses, and ROI for initiatives (navigation, PBM strategies, care management, virtual care).
• Evaluate plan design alternatives (e.g., HSA‑HDHP, tiered networks, COE, reference‑based pricing) with financial, clinical, and member impact analysis.

Vendor Strategy & Market Engagement

• Lead marketings/competitive RFPs for medical, PBM, dental/vision, life/AD&D/DI, leave/absence, EAP, cost navigation, advocacy, point solutions, and ben‑admin/HRIS.
• Negotiate performance guarantees, pricing, rebates, formulary strategy, and clinical programs in collaboration with actuarial and pharmacy specialists.
• Maintain strong carrier/TPA/PBM relationships and stay current on emerging solutions and underwriting trends.

Compliance, Governance & Risk

• Ensure alignment with ACA, ERISA, COBRA, HIPAA, MHPAEA (parity), Section 125, transparency in coverage, Rx reporting, and state/local requirements.
• Establish client governance models, documentation standards, and implementation controls that stand up to audit and public scrutiny.
• Oversee SPD/SBC review, plan documents, and filing calendars; coordinate with legal/compliance resources as needed.

People Leadership & Delivery Excellence

• Lead multi‑disciplinary teams (consultants, actuaries, analysts, clinical/pharmacy SMEs); ensure quality, timeliness, and client satisfaction.
• Coach and develop talent; set performance expectations and promote knowledge sharing, templates, and best practices.
• Implement delivery playbooks, QA standards, and issue‑escalation protocols across accounts.

Growth, Thought Leadership & Community Presence

• Expand wallet share through strategic roadmaps, cross‑sell/upsell (retirement, wellbeing, P&C/stop‑loss, workforce analytics), and net‑new pursuits.
• Lead pursuits: solution shaping, pricing, proposals, orals/finalist presentations; contribute to points of view, whitepapers, webinars, and conference speaking.

Qualifications

• 10-15+ years in Health & Benefits consulting or brokerage with progressive client leadership responsibility.
• Demonstrated success leading complex, multi‑vendor benefits programs for mid‑large or jumbo employers.
• Strong command of funding mechanics, underwriting principles, stop‑loss, PBM economics, and benefits compliance.
• Excellent executive presence with superior communication, presentation, and facilitation skills.
• Bachelor's degree required; advanced degree (MBA, MPH, MHA) preferred.
• Professional credentials strongly preferred (e.g., CEBS, GBA/RPA, JD, ASA/actuarial background, pharmacist/clinical credentials for pharmacy leadership tracks).