Vice President Health Plan Operations
Core
Lead core Operations departments for a health plan, overseeing daily operations, strategy, efficiency, claims, member services, sales, enrollment, and compliance.
Role type
Vice President, Health Plan Operations
Builds
Health plan operational processes and systems for members and stakeholders
Domain
Healthcare / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure | physical/clinical work
Required skills
Leadership, P&L accountability, Managed care models (HMO, PPO, Medicaid, Medicare Advantage), Regulatory compliance (CMS, HIPAA), Budget management, Team development, New product implementation, Health plan operations systems oversight
Preferred skills
WV Managed Care Medicaid Program experience, Large core admin implementation projects (100k+ covered lives)
Technologies
Claims adjudication platforms, CRM tools
Responsibilities
Lead daily operations, strategy, and efficiency for a health plan; Oversee claims, member services, sales, and enrollment; Ensure compliance with CMS, HIPAA, and other regulations; Manage budgets and drive digital initiatives; Recruit, retain, and develop high-performing teams; Act as senior liaison between product lines, business units, and external stakeholders.
Seniority
Executive, strategic leadership & mentorship
