Director of Operations

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Take charge of daily operational execution across ASO, Fully Insured, ACA, and Stop-Loss lines of business.

• Ensure that operational teams provide accurate, timely, compliant, and high-quality services.

• Foster accountability among teams regarding service levels, productivity, quality, turnaround times, and commitments to clients.

• Oversee operational priorities, workload capacity, resource distribution, and overall business performance.

• Guarantee operational consistency across various lines of business while addressing the distinct needs of self-funded ASO administration, Fully Insured plan operations, ACA workflows, and stop-loss administration.

• Recognize operational risks and opportunities while implementing solutions to enhance performance, reliability, and client experience.

• Supervise the execution of claims administration, eligibility coordination, billing support, stop-loss administration, carrier collaboration, recoveries, and operational controls.

• Ensure that claims and operational processes adhere to quality, compliance, financial, and service standards.

• Track claims and stop-loss performance, pinpoint challenges, and apply corrective measures.

• Collaborate with internal teams and external stakeholders to address operational issues and enhance outcomes.

• Recruit, develop, mentor, and retain high-performing operational teams and leaders.

• Set clear performance expectations, leadership capabilities, and opportunities for professional development.

• Cultivate a culture of accountability, collaboration, continuous improvement, and customer-centric execution.

• Enhance organizational capacity to accommodate business growth and evolving operational demands.

• Guide managers and teams through operational changes while ensuring engagement and buy-in.

• Establish and manage operational KPIs, SLAs, quality standards, productivity measures, and service performance objectives.

• Monitor operational outcomes and implement improvement plans when performance expectations are not fulfilled.

• Maintain awareness of operational trends, risks, opportunities, and business results.

• Provide leadership with insights and recommendations to enhance operational effectiveness.

• Assist in identifying opportunities to boost operational efficiency, simplify processes, and improve service delivery.

• Ensure operational teams effectively adopt and sustain new processes, technologies, and operational practices.

• Support ongoing improvement initiatives by identifying root causes, refining workflows, and enhancing operational discipline.

• Ensure compliance with relevant federal and state regulations, contractual obligations, internal policies, and healthcare industry standards.

• Aid in audit readiness, quality assurance initiatives, and operational governance activities.

• Maintain appropriate operational controls and risk management protocols.

• Ensure teams operate within established compliance and quality benchmarks.

• Collaborate with Technology, Finance, Compliance, Client Success, Implementation, Transformation, and Executive Leadership to resolve operational challenges and support business objectives, while also engaging in initiatives involving process improvement, automation, technology enablement, and organizational change.

• Communicate operational performance, priorities, risks, and recommendations to executive leadership.

• Translate business strategy into effective operational execution.

⛳️ Requirements

• Extensive leadership experience in a third-party administrator (TPA), self-funded health plan, managed care, or health insurance setting.

• In-depth knowledge of claims administration, stop-loss operations, healthcare operations, and employer-sponsored health plans.

• Proven track record of successfully managing complex healthcare operations with accountability for service delivery, team performance, operational metrics, and organizational growth.

• Experience in managing operational teams, workforce planning, and performance enhancement initiatives.

• Demonstrated ability to foster accountability, enhance service delivery, and scale operational capabilities.

• Strong understanding of claims adjudication, eligibility, enrollment, billing operations, EDI transactions, stop-loss administration, and self-funded health plan processes.

• Experience in supporting ACA, Fully Insured, ASO, and stop-loss operations.

• Familiarity with stop-loss administration, including specific and aggregate recovery processes.

• Experience utilizing claims administration platforms, workflow tools, operational reporting, dashboards, and analytics to improve operational results.

• Ability to partner effectively with Technology and Transformation teams to implement operational enhancements.

• Experience leveraging data and performance metrics to identify opportunities and promote accountability.

• Strong leadership, communication, and stakeholder management abilities.

• Capability to develop teams, influence partners, solve intricate operational challenges, and communicate effectively with executive leadership.

• Ability to translate operational strategy into execution while collaborating across various functions.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and career advancement.

• A collaborative and inclusive work environment.

• Flexible work arrangements.

• Competitive salary and performance-based incentives.