Director of Plan Operations

Russell Tobin's client, a health benefits administration platform company, is hiring a Hybrid Director of Plan Operations (Health Plans & Benefits Administration) in Lehi, UT, or Plano, TX

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Employment Type: Contract/Hybrid

Location: Hybrid, Lehi, UT or Plano, TX

Duration: 3+ months with possible extension or conversion

Pay range: $66/hr - $86/hr W2

Work schedule: Mon – Fri

Role Summary

We are seeking a Director, Plan Operations Contractor who will be 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 Director 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 the onboarding and system programming of 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 and configuration of complex benefit plans within claims adjudication systems.
• Ensure configuration integrity and accuracy through comprehensive quality assurance processes.
• Leverage deep expertise in third-party administration (TPA) systems to support operational excellence.

Plan Operations Strategy

• Develop and execute strategies to improve the efficiency, accuracy, scalability, and effectiveness of plan operations.

Health Plan Administration

• Oversee implementation and ongoing administration of client benefit plans.
• Ensure accuracy in plan configuration and related documentation, including Summary Plan Descriptions (SPDs) and Summary Benefits and Coverage (SBCs).

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, Client Success, and other internal stakeholders to ensure adherence to applicable federal, state, and industry regulations, including ERISA, ACA, HIPAA, CMS requirements, and related standards.

Stakeholder Collaboration

• Collaborate with Product, Engineering, Client Success, Customer Experience, and external stakeholders to improve operational processes and resolve complex issues.
• Recommend benefit solutions and enhancements that increase automation while meeting client needs.

Performance Management

• Establish and monitor key performance indicators (KPIs) to measure operational success and drive continuous improvement.
• 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 managing escalations, resolving operational challenges, and improving client satisfaction.
• Participate in client and prospective client meetings to communicate operational capabilities, performance metrics, and strategic recommendations.

Technology & Automation

• Partner with Product and Engineering teams to implement technology-driven solutions that improve efficiency, accuracy, and scalability of plan operations.

Qualifications

Required

• 10+ years of experience in health plan administration, benefits operations, or a related field.
• At least 3 years of direct, hands-on 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 administration platforms such as Facets, QNXT, HealthRules, or similar TPA/Payer systems.
• Demonstrated expertise translating complex benefit designs and logic into accurate system configurations.
• Deep understanding of self-funded health plans, third-party administration, and healthcare regulatory requirements.
• Proven success managing large-scale operations, process improvement initiatives, and operational excellence programs.
• Strong analytical, problem-solving, and decision-making skills with a data-driven approach.
• Excellent leadership, communication, and stakeholder management skills.
• Experience operating in fast-paced, high-growth environments with a focus on change management, innovation, and continuous improvement.

Preferred

• Certified Coding Specialist (CCS) certification or similar credential.

Benefits that Russell Tobin offers:

Russell Tobin 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

Russell Tobin 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

Russell Tobin 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.