VP, Core Operations

VP, Core Operations

The Vice President, Core Operations will provide strategic and transformational leadership for key operational teams including Claims Operations, Electronic Data Interchange Operations, Product & Network Configuration, Enrollment Billing and Reconciliation, and Payment Integrity & Special Investigation. This executive leader will drive operational excellence, collaborate with internal and external stakeholders, ensure regulatory compliance and improve the member and provider experience with Medica. The VP, Core Operations plays a pivotal role in several key transformation initiatives for Medica and will require cross-functional leadership and influencing skills. This position will lead a team of experienced Senior Directors & Directors and will report directly to the Chief Operating Officer.

This is a great opportunity to transform the existing operational foundation, refine and strengthen key processes and drive strategic and transformation initiatives as part of Medica's transformation agenda.

Key Accountabilities:

• Lead strategy and execution for the Core Operations teams and ensures alignment with the Enterprise strategic roadmap and plan.
• Direct and oversee configuration, enrollment, billing and reconciliation, claims processing, Electronic Data Interchange operations, and payment integrity business processes across all market segments and product lines to ensure accuracy, efficiency, and compliance.
• Collaborate with the Core Operations leadership team and key internal/external stakeholders on business process improvement initiatives leveraging automation, analytics and industry best practices to drive operational efficiencies, improve member experiences and reduce costs.
• Partner with internal teams (Technology, Compliance, Affordability, Customer Service, Finance and Markets) on daily operations and to drive strategic initiatives.
• Manage business process outsourcing (BPO) strategy and BPO partner relationships to enhance operational scalability and improve performance.
• Develop and monitor new/revised metrics/KPIs (key performance indicators) on annual basis to enhance operational performance, timeliness and accuracy for accountable teams.
• Responsible for managing department's budget, forecast performance, and administrative expenses to ensure sustainability for the health plan.
• Be a change leader in partnership with internal teams to ensure appropriate change management is in place to execute on key transformation initiatives and operational improvements.
• Lead, coach and develop a team of Senior Directors/Directors fostering accountability, collaboration, continuous improvement and operational excellence.
• Represent Medica in industry forums to stay connected to best practices and policy changes.

Qualifications:

• Bachelor's degree or equivalent experience in related field, plus 15 years of work experience beyond degree; with at least 5 years at senior management level; or equivalent combination of education and experience required
• 10 years of experience in the health plan operations with specific experience with health claims operations, payment integrity, enrollment, billing and reconciliation or related functions required
• Experience working with senior management across multiple teams and organizations
• Experience in being part of large, cross functional projects & programs

Skills and Abilities:

• Demonstrated self-starter with solid planning organization, analytical and problem-solving skills
• Excellent leadership, facilitation and project management skills and a collaborative management style that facilitates working with leaders at all levels of a highly matrixed organization
• Advanced, executive-level communication and presentation skills
• Strong working knowledge of CMS, Medicaid, Medicare Advantage, ACA and commercial health plan regulations.
• Ability to select, negotiate and manage BPO partners with performance goals and service level agreements
• Very effective interpersonal skills including mentoring, coaching, collaborating, and team building
• Proven ability to manage budgets, drive process improvements and lead strategic initiatives

This position is an Office role, which requires an employee to work from the designated office, Minnetonka MN or Madison WI, on average, 3+ times per week.

The full base pay salary range for this position is $260,000-$390,000. Annual base pay salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and or licensures, the position's scope and responsibility, internal pay equity and external market salary data.

In addition to base compensation, this position is eligible for Medica's Short Term Incentive plan, Long Term Incentive plan and our Supplemental Executive Retirement Plan.

Medica offers a generous total rewards package that includes competitive medical, dental, vision, executive life insurance, Self-Managed Time Off, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.