The Director of Health Plan Operations will spearhead strategic undertakings including but not limited to claims, enrollment, member services, provider relations, and network management, with aims to enhance operational efficiency, elevate member satisfaction, and drive organizational growth.
Effective communication and negotiation with partners are paramount for driving successful outcomes and advancing our mission of delivering accessible, high-quality healthcare at a lower cost to our diverse membership. We are seeking career-driven health plan executives with proven relationship-building skills and expertise in utilization, claims, and implementation. We offer accelerated growth, excellent benefits, and opportunities.
Job Specifications:
· Provide leadership, guidance, and support to operational departments, including claims, enrollment, member services, provider relations, and network management
· Develop and manage department budgets, ensuring financial accountability and resource optimization.
· Set clear performance goals and expectations for direct reports and hold them accountable for results.
· Foster a culture of continuous learning, collaboration, and employee development.
· Ensure compliance with regulatory requirements and adherence to industry best practices.
· Establish performance metrics and targets to monitor and evaluate operational performance.
· Identify and implement process improvement initiatives to enhance efficiency and quality of services.
· Collaborate with executive leadership to align operational strategies with overall business objectives.
· Communicate effectively with internal and external stakeholders to ensure alignment and successful outcomes.
· Support executive leadership in special projects and initiatives as needed
· Resolve issues by identifying the problem, examining solution options, implementing an action plan and providing resources.
· Work in close collaboration with vendor partners to ensure the plan is running efficiently.
· Spearhead the installation of new vendor partners.
· Evaluate and assess any gaps in the product and offer new recommendations and/or solutions.
Requirements
· 5+ years Health Plan Operations experience
· Ability to work in a fast-paced environment
· Team Player
· Mission Driven
· Self-Motivated
· Knowledge of self-insured health plans
· Ability to plan, organize, and manage multiple priorities
· Previous management experience
· Possess strong interpersonal skills
Job Type: Full-time
Pay: $101,397.00 - $112,832.00 per year
Benefits:
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Application Question(s):
- Do you have level-funded or self-funded health insurance experience?
Experience:
- Health Plan Operations: 5 years (Required)
Work Location: Remote
