Chief Operating Officer (COO) with (self-funded and Stoploss)

Executive Opportunity – Chief Operating Officer (COO) Location: Onsite (Daily Office Presence Required) We are seeking an experienced Chief Operating Officer (COO) to lead operations for a growing Third-Party Administrator (TPA) supporting self-funded health plans . This executive leadership role will report directly to the CEO and be responsible for operational excellence, vendor management, regulatory compliance, and strategic growth initiatives. What You'll Lead Claims Administration Eligibility & Enrollment Operations Member & Employer Group Services Billing & Reconciliation Plan Administration Vendor & Partner Ecosystem Management Operational Performance & Continuous Improvement Key Responsibilities Drive day-to-day operational execution across all TPA functions. Establish and monitor KPIs including claims turnaround, accuracy, service levels, and operational efficiency. Oversee relationships with stop-loss/reinsurance carriers, PBMs, provider networks, utilization management vendors, actuaries, and technology partners. Lead contract negotiations, SLA management, and vendor performance reviews. Partner with finance, actuarial, and clinical teams to manage healthcare costs, trends, and risk exposure. Ensure compliance with ERISA, ACA, HIPAA, COBRA, and applicable regulations. Develop scalable processes, controls, and operational roadmaps to support growth. Provide executive reporting and strategic recommendations to the CEO and Board. Required Qualifications ✅ Experience working within a TPA supporting self-funded employer groups ✅ Direct experience managing stop-loss/reinsurance carriers and PBMs ✅ Senior leadership experience (Director, VP, or C-Level) in healthcare benefits administration, TPAs, or self-funded health plans ✅ Deep understanding of claims administration, eligibility, enrollment, and self-funded plan operations ✅ Strong knowledge of ERISA, ACA, HIPAA, and COBRA regulations ✅ Proven vendor management and contract negotiation expertise ✅ Demonstrated success building scalable operational organizations Preferred Qualifications Experience implementing or migrating claims administration platforms Knowledge of reference-based pricing and cost-containment strategies Experience working with brokers, consultants, and employer groups Experience scaling a TPA through growth or acquisition Core Competencies Operational Excellence Strategic Leadership Vendor Governance Financial & Risk Management Regulatory Compliance Data-Driven Decision Making Client & Stakeholder Management This is an outstanding opportunity for a proven healthcare operations leader to make a significant impact within a growing organization serving self-funded employer groups.