Director, Plan Operations
Private Company
We are partnering with a high-growth healthcare technology organization seeking a Director, Plan Operations (Contract) to lead and optimize health plan administration at scale. This is a high-impact leadership role responsible for driving operational excellence across plan configuration, benefit administration, and claims-related processes while ensuring compliance and an exceptional client and member experience.
Responsibilities:
- Lead and develop a team supporting plan configuration and onboarding
- Oversee complex benefit setup within claims/TPA systems, ensuring accuracy and quality
- Drive process improvements to enhance efficiency, scalability, and turnaround times
- Ensure compliance with ERISA, ACA, HIPAA, and other regulations
- Partner cross-functionally with Product, Engineering, Client Success, and Compliance teams
- Monitor KPIs and system performance to drive operational excellence
- Support client needs, escalations, and overall service delivery
Qualifications
- 10+ years in health plan administration or benefits operations
- Hands-on experience with TPA/payer systems (e.g., Facets, QNXT, HealthRules)
- Strong understanding of benefit design, claims systems, and regulatory requirements
- Proven leadership, process optimization, and stakeholder management experience
- Analytical, detail-oriented, and comfortable in fast-paced environments
Preferred:
- Certified Coding Specialist (or similar certification)
If interested and to learn more, apply today!
Vacancy posted 1 day ago
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