Healthcare Operations Strategy Consultant

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

📋 Description

• Lead the design of service models and create solution blueprints for transformation initiatives in health plan Core Administration.

• Evaluate current operations on legacy systems and outline transition pathways to BPaaS delivery models within the HealthEdge ecosystem.

• Craft future-state operating models that encompass claims, enrollment, billing, provider relations, utilization management (UM), appeals and grievances (A&G), benefits administration, and member operations.

• Define the interconnections of BPaaS service layers within the health plan ecosystem.

• Spot opportunities to integrate automation, AI-driven workflows, and intelligent process orchestration into operational service frameworks.

• Create business cases that illustrate enhancements in cost reduction, operational efficiency, scalability, and compliance.

• Perform assessments of current-state Core Administration operations, staffing structures, and process maturity.

• Develop modernization roadmaps and strategies for platform transitions that align with operational realities and the business priorities of health plans.

⛳️ Requirements

• Over 5 years of experience in health plan operations, Core Administration, or healthcare BPaaS strategy.

• Extensive operational knowledge in one or more Core Administration areas: claims, enrollment, billing, benefits administration, utilization management, appeals and grievances, provider, and member services.

• Previous experience in consulting, managed services, or advisory roles within a health plan, systems integrator (SI), or BPaaS vendor.

• Demonstrated ability to evaluate operational models and design future-state BPaaS service blueprints.

• Strong familiarity with Core Administration platforms such as HealthRules Payer, Facets, QNXT, QicLink, Javelina, or similar systems.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Paid time off

• Remote work options

• Professional development