Vice President of Operations

📋 Description

• Define clear operational ownership, performance expectations, and accountability among teams, while ensuring operational readiness to facilitate growth, new market launches, and adapting to regulatory changes.

• Lead the Payment Integrity strategy and implementation, which includes prevention, detection, investigation, and prompt documentation and resolution activities, as well as designing and supervising operational controls to guarantee accurate payments, minimize overpayments, and reduce financial leakage.

• Collaborate with Compliance and Regulatory Operations teams to develop workflows, escalation procedures, and documentation standards for identifying, investigating, proactively mitigating risks, and addressing potential fraud, waste, and abuse (FWA), ensuring proper tracking, reporting, and visibility for leadership regarding trends and outcomes.

• Create standardized, auditable, and scalable processes, driving meticulous documentation of operational workflows, standard operating procedures (SOPs), controls, and interdependencies across HPS, while working with IT and Analytics to facilitate workflow automation and system-enabled controls where applicable.

• Establish and monitor operational KPIs, SLAs, and performance metrics, utilizing data and reporting to pinpoint bottlenecks, risks, and opportunities for enhancing efficiency and quality, as well as leading continuous improvement initiatives to bolster execution, minimize rework, and ensure proactive escalation and resolution of operational issues and risks.

• Act as an effective communicator across HPS and enterprise partners, translating complex operational challenges into clear and concise updates for executive leadership, while closely collaborating with Regulatory Operations to support audit readiness, regulatory responses, and sustainable remediation.

• Lead and mentor senior operational leaders and their teams, including responsibilities for hiring, coaching, performance management, succession planning, and fostering a culture of accountability, ownership, documentation discipline, and continuous improvement.

⛳️ Requirements

• A Bachelor’s degree in healthcare administration, business administration, finance, operations management, or a related field is required.

• A Master’s degree in healthcare administration, public health, business administration, or a related field is strongly preferred.

• Formal training or certifications in operations management, payment integrity, compliance, fraud prevention, quality, or analytics are preferred.

• A minimum of ten (10) years of progressive experience in leading healthcare or health plan operations.

• At least five (5) years of senior leadership experience managing multi-layered operational teams.

• Demonstrated expertise in Payment Integrity programs, financial controls, and operational risk management.

• Proven experience in leading or supporting FWA detection and prevention initiatives.

• A strong history of establishing scalable, well-documented operational workflows and control environments.

• Exceptional written and verbal communication abilities, with a proven track record of clearly documenting processes and conveying complex information.

🏝️ Benefits

• Medical insurance coverage (Medical, Dental, Vision)

• Work/life balance - We mean it! 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!