Health Plan Operations Lead

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Requirements:

• 5+ years in health plan operations or a related role, preferably in value-based care or care navigation.
• Background in tech-enabled, early-stage companies with a focus on innovative process design.
• Hands-on experience with 3rd party partners/vendors.
• Strong project management skills with a proven track record.
• Data-driven mindset with experience in data analysis.
• Excellent interpersonal and communication skills.
• Familiarity with healthcare operations tools.

Responsibilities:

• Build, manage and optimize end-to-end health plan operations processes, including enrollment, claims, billing, and customer support.
• Coordinate with key stakeholders to ensure seamless operations and alignment with product strategy.
• Implement SOPs and KPIs with stakeholders.
• Oversee vendor relationships and ensure SLAs are met.
• Identify and implement workflow improvements for operational efficiency.
• Utilize data analytics to monitor performance and propose solutions.
• Ensure regulatory compliance and support audits.