Director of Operations - REMOTE

Responsibilities

• Own day-to-day operational execution across ASO, Fully Insured, ACA, and Stop-Loss lines of business.
• Ensure operational teams deliver accurate, timely, compliant, and high-quality services.
• Establish accountability across teams for service levels, productivity, quality, turnaround times, and client commitments.
• Manage operational priorities, workload capacity, resource allocation, and business performance.
• Ensure operational consistency across lines of business while managing the unique requirements of self-funded ASO administration, Fully Insured plan operations, ACA workflows, and stop-loss administration.
• Identify operational risks and opportunities while implementing solutions to improve performance, reliability, and client experience.
• Oversee execution of claims administration, eligibility coordination, billing support, stop-loss administration, carrier collaboration, recoveries, and operational controls.
• Ensure claims and operational processes meet quality, compliance, financial, and service expectations.
• Monitor claims and stop-loss performance, identify challenges, and implement corrective actions.
• Partner with internal teams and external stakeholders to resolve operational issues and improve outcomes.

Qualifications

• Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance environment.
• Deep knowledge of claims administration, stop-loss operations, healthcare operations, and employer-sponsored health plans.
• Demonstrated success leading complex healthcare operations with responsibility for service delivery, team performance, operational metrics, and organizational growth.
• Experience managing operational teams, workforce planning, and performance improvement initiatives.
• Proven ability to establish accountability, improve 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 supporting ACA, Fully Insured, ASO, and stop-loss operations.
• Working knowledge of stop-loss administration, including specific and aggregate recovery processes.
• Technology & Analytics Experience using claims administration platforms, workflow tools, operational reporting, dashboards, and analytics to improve operational outcomes.
• Ability to partner effectively with Technology and Transformation teams to implement operational improvements.
• Experience using data and performance metrics to identify opportunities and drive accountability.
• Strong leadership, communication, and stakeholder management skills.
• Ability to develop teams, influence partners, solve complex operational challenges, and communicate effectively with executive leadership.