• Assess health plan core administration technology and operations across claims, enrollment, billing, and service
• Identify root-cause drivers of cost, quality, and compliance gaps
• Translate assessment findings into future-state roadmaps and business/technology blueprints positioning BPaaS as a path to improved outcomes
• Quantify opportunities including cost takeout, service-level improvement, and error reduction
• Build financial models covering ROI, IRR, and cost-benefit analysis
• Define accountability across the advisory engagement lifecycle
• Identify automation and AI-driven processes to streamline administrative tasks, reduce manual error, and strengthen transformation cases
• Partner with Sales, solution, and delivery teams to translate roadmaps and business cases into executable operating models
• Build and sustain relationships with client stakeholders from analyst to C-suite
• Provide competitive intelligence and assess regulatory shifts, including CMS and state Medicaid, and platform capabilities
• Report to the Chief Strategy Officer
• Work across multiple time zones and use video technology in a hybrid or remote work environment
• Travel as needed based on company requirements
Requirements
- 10+ years in health plan operations leadership or consulting focused on health plan operations, including claims, enrollment, billing, and member/provider service
- Track record of managing teams, leading operational assessments, and translating findings into board or C-suite-ready recommendations
- Experience evaluating in-flight or prior transformation initiatives
- Working knowledge of core administrative platforms such as HealthRules Payer, Facets, QNXT, and QicLink
- Financial modeling experience including outcome-based pricing, cost-benefit analysis, ROI, and IRR
- Experience structuring and positioning transformation or BPaaS-style solutions for complex, multi-stakeholder deals
- Demonstrated ability to build and grow relationships with operations leadership from director level through C-suite
- Ability to manage ambiguity and determine which questions to ask when data is incomplete
- Team leadership skills, including delegation and accountability for outcomes
- May be required to undergo a pre-employment criminal background check
Core Competencies
Demonstrates extensive expertise in health plan operations leadership, focusing on claims, enrollment, billing, and service. Proficient in financial modeling, relationship management, and translating operational assessments into strategic recommendations for C-suite stakeholders.
Highest-signal resume keywords
- Health Plan Operations Leadership
- Financial Modeling
- Core Administrative Platforms
- Transformation Solutions Structuring
- Team Leadership
Hard Skills
- Financial Modeling
- Cost-Benefit Analysis
- ROI
- IRR
- Operational Assessment
- Data Analysis
- Automation Processes
- AI-Driven Solutions
- Business Case Development
- Future-State Roadmaps
Soft Skills
- Relationship Building
- Team Leadership
- Managing Ambiguity
- Communication
- Delegation
Industry Keywords
- Health Plan Operations
- Claims
- Enrollment
- Billing
- Member/Provider Service
- CMS
- Medicaid
- BPaaS
- Competitive Intelligence
- Stakeholder Engagement
Tools & Technologies
- HealthRules Payer
- Facets
- QNXT
- QicLink
- Video Technology
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VP, Advisory Operations Arbeitgeber: Jobtailor
Als Front Office Supervisor in unserem dynamischen Team bieten wir Ihnen die Möglichkeit, in einem unterstützenden und freundlichen Arbeitsumfeld zu wachsen. Wir legen großen Wert auf die berufliche Entwicklung unserer Mitarbeiter und bieten regelmäßige Schulungen sowie die Chance, Verantwortung zu übernehmen. Unsere Lage ermöglicht es Ihnen, Teil einer lebendigen Gemeinschaft zu sein, während Sie gleichzeitig die Standards unseres Franchise-Partners einhalten und unseren Gästen einen unvergesslichen Aufenthalt bieten.
