Director of Plan Operations

Job Description 3-month contract with possibility of extension Pay Range:- 85.00/hr- 91.00/hr. Location:- Lehi, UT Plano, TX Director, Plan Operations Position Overview We are seeking a Director, Plan Operations Contractor responsible for ensuring the seamless execution and operational performance of health plan administration. This individual will oversee plan operations strategy, execution, and optimization to drive efficiency, compliance, and an excellent client and member experience. The role will collaborate cross-functionally with internal teams, external partners, and clients to ensure operational excellence in plan configuration, benefit administration, and issue resolution. Key Responsibilities Team Leadership & Development Build and lead a high-performing team of system configuration specialists, plan design specialists, and analysts supporting onboarding and systemic plan programming for self-funded clients Foster a culture of accountability, innovation, and continuous learning Provide coaching, mentorship, and professional development opportunities to enhance team capabilities Systemic Plan Programming & Technical Oversight Provide senior technical oversight for the systematic programming (coding) of complex benefit plans within the claims adjudication system Ensure configuration integrity and accuracy through comprehensive quality assurance processes Leverage deep knowledge of third-party administration (TPA) systems to support operational excellence Plan Operations Strategy Develop and execute strategies to improve the efficiency, accuracy, and scalability of plan operations Health Plan Administration Oversee implementation and ongoing management of client benefit plans Ensure accuracy in plan configuration and plan-related documents including Summary Plan Descriptions and Summary Benefits of Coverage Process Optimization Identify and implement best practices to streamline workflows, optimize system performance, reduce errors, and improve turnaround times Compliance & Risk Management Partner with Compliance, Legal, and Client Success teams to ensure adherence to federal, state, and industry regulations including ERISA, CMS, ACA, HIPAA, and related requirements Stakeholder Collaboration Collaborate with Product, Engineering, Client Success, and Customer Experience teams to enhance workflows and resolve operational issues Work with internal and external stakeholders to identify benefit solutions and automation enhancements that support client needs Performance Management Establish and monitor KPIs to measure operational success and identify improvement opportunities Monitor system performance and address issues related to configuration accuracy, plan language, claims adjudication, and payment integrity Client & Member Support Ensure high-quality service delivery by resolving escalations and operational challenges while improving client satisfaction Participate in client meetings alongside Client Success and Sales teams to present operational capabilities, address concerns, and provide recommendations Technology & Automation Partner with Product and Engineering teams to implement technology-driven solutions that improve efficiency and operational accuracy Qualifications 10+ years of experience in health plan administration, benefits operations, or related fields Minimum 3 years of direct technical experience in a Third-Party Administrator (TPA) or Payer environment focused on health plan coding, benefit configuration, or claims system setup Strong proficiency with enterprise benefit platforms such as Facets, QNXT, HealthRules, or similar TPA/Payer systems Expertise translating complex benefit logic into accurate system configuration and coding Deep understanding of self-funded health plans, third-party administration, and regulatory requirements Proven success managing large-scale operations, process optimization, and operational improvement initiatives Strong analytical, problem-solving, and data-driven decision-making skills Excellent communication, leadership, and stakeholder management abilities Experience working in fast-paced, high-growth environments focused on innovation and continuous improvement Certified Coding Specialist certification preferred, but not required PrideGlobal and it's affiliates offers eligible employee's comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance and employee discounts with preferred vendors. Equal Employment Opportunity PrideGlobal and it's affiliates are an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law. Fair Chance Employment PrideGlobal and it's affiliates are a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances. Accommodations We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us. Only applicable for San Francisco Candidates : Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.