Vice President of Operations

Role Description

Reporting directly to the SVP, Health Plan Services (HPS), the VP, Operations is a core member of the HPS leadership team, accountable for translating strategy into execution, ensuring strong documentation and operational discipline, and building scalable systems to support growth, delegation, and multi‑state expansion. The VP, Operations leads and scales all HPS operational functions to ensure efficient, compliant, and high‑performing execution across WelbeHealth’s payer operations.

This role is different because the VP, Operations at WelbeHealth:

• Leads enterprise-wide HPS operations with direct ownership over operational performance, payment integrity, fraud, waste, and abuse (FWA) prevention, and scalable process execution that supports organizational growth and compliance.
• Serves as a strategic operational leader across the organization — partnering with executive leadership, Compliance, Finance, Regulatory Operations, IT, and Clinical teams to drive operational excellence, strengthen controls, and implement scalable systems that improve efficiency, reduce risk, and support expansion.

On the day-to-day, you will:

• Establish clear operational ownership, performance expectations, and accountability across teams, as well as ensure operational readiness to support growth, new market launches, and evolving regulatory requirements.
• Own Payment Integrity strategy and execution, including prevention, detection, investigation, and timely documentation and resolution activities, as well as design and oversee operational controls to ensure accurate payment, minimize overpayments, and reduce financial leakage.
• Partner with Compliance and Regulatory Operations teams to establish workflows, escalation paths, and documentation standards for identifying, investigating, proactively mitigating risk, and addressing potential FWA, all while ensuring appropriate tracking, reporting, and leadership visibility into trends and outcomes.
• Establish standardized, auditable, and scalable processes and drive rigorous documentation of operational workflows, SOPs, controls, and interdependencies across HPS, as well as partner with IT and Analytics to enable workflow automation and system‑enabled controls where appropriate.
• Define and monitor operational KPIs, SLAs, and performance metrics, using data and reporting to identify bottlenecks, risks, and opportunities for efficiency and quality improvement, as well as lead continuous improvement initiatives to strengthen execution, reduce rework, and ensure operational issues and risks are proactively escalated and resolved.
• Serve as a strong communicator across HPS and enterprise partners, translating complex operational issues into clear, concise updates for executive leadership, as well as partner closely with Regulatory Operations to support audit readiness, regulatory responses, and sustainable remediation.
• Lead and develop senior operational leaders and their teams, including hiring, coaching, performance management, succession planning, and building a culture of accountability, ownership, documentation discipline, and continuous improvement.

Qualifications

• Bachelor’s degree in healthcare administration, business administration, finance, operations management, or a related field required.
• Master’s degree in healthcare administration, public health, business administration, or a related field strongly preferred.
• Formal training or certifications in operations management, payment integrity, compliance, fraud prevention, quality, or analytics preferred.
• Minimum of ten (10) years of progressive experience leading healthcare or health plan operations.
• Minimum of five (5) years of senior leadership experience managing multi‑layered operational teams.
• Demonstrated experience with Payment Integrity programs, financial controls, and operational risk management.
• Proven experience leading or supporting FWA detection and prevention efforts.
• Strong track record of building scalable, well‑documented operational workflows and control environments.
• Exceptional written and verbal communication skills with a demonstrated ability to clearly document processes and convey complex information.

Benefits

• Medical insurance coverage (Medical, Dental, Vision).
• Work/life balance - 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days.
• 401K savings + match.
• Comprehensive compensation package including base pay and bonus.
• And additional benefits!

Compensation Offering

$224,800.12 — $309,100.17 USD

COVID-19 Vaccination Policy

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer.