Senior Director, Health Fund Ops & Admin

About the role

The Senior Director, Health Fund Operations and Administration is a senior operational and strategic leader responsible for the systems, vendors, people, processes, and data that support the Health Fund's operations.

This role focuses on ensuring that member interactions are handled effectively and professionally, vendor relationships are managed to maximize value and performance, and administrative expenditures are appropriately tracked, measured, and reported.

This role reports directly to the Managing Director, Health Fund and serves as a senior strategic partner, providing operational leadership, data-driven insights, and administrative oversight to support the Fund's strategic and operational objectives.

Essential Duties and Responsibilities

• Leads and oversees Health Fund analytics, product management, and technology functions, ensuring efficient, compliant, and member-centered service delivery.

• Led ongoing efforts to identify and implement long-term strategic enhancements to Health Fund operations, including member services, plan administration, analytics, product management and technology functions.

• Establishes service standards and operational performance metrics for member-facing functions, monitors outcomes, identifies root causes of service issues, and drives continuous improvement initiatives to enhance the member experience.

• Oversees the strategic direction of non-provider vendors, including the Third-Party Administrator (TPA), Pharmacy Benefit Manager (PBM), and ancillary benefit vendors: vision, dental, maternity, and surgical bundling (Lantern); ensuring both immediate and long-term value objectives are achieved.

• Directs vendor governance processes, including performance reviews, issue resolution, improvement initiatives, contract administration, and recommendations regarding vendor selection, renewal, or transition.

• Leads the Health Fund's analytics, data management, reporting, product management, and technology functions, ensuring the effective collection, governance, integration, analysis, and utilization of data to support operational performance and strategic decision-making.

• Serves as a strategic advisor and thought partner to the Managing Director, Health Fund, providing operational administrative, and data-driven insights to support organizational strategy, risk management, and decision-making.

• Identifies operational risks, process inefficiencies, emerging trends, and strategic opportunities, and develops recommendations to strengthen performance, improve member outcomes, and enhance organizational effectiveness.

• Develops and mentors a multidisciplinary leadership team responsible for Health Services, Hospital and Medical Operations, Ancillary Benefits, Analytics, and Product & Engineering functions.

• Fosters a culture of accountability, collaboration, continuous improvement, innovation, and member-centered service across all areas of responsibility.

• Collaborates with internal departments, vendors, consultants, and external stakeholders to support strategic initiatives, operational priorities, and cross-functional projects.

• Provides operational leadership, resources, and subject matter expertise to support the successful implementation of organizational and Health Fund strategic initiatives.

Qualifications (Competencies)

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, Information Systems, or a related field required; Master’s degree preferred;
• Significant experience in health plan operations, benefits administration, managed care, or a related healthcare environment, with accountability for multiple operational functions required;
• Demonstrated experience managing third-party vendors, including TPAs, PBMs, or ancillary benefit vendors, with responsibility for performance management, contract oversight, procurement activities, and vendor accountability required;
• Strong knowledge of self-funded health plan operations, ERISA fiduciary responsibilities, and regulatory requirements related to plan administrations, including Summary Plan Descriptions (SPDs), Summaries of Benefits and Coverage (SBCs), and vendor compensation disclosures required;
• Experience leading or overseeing analytics, reporting, data management, technology, or operational support functions within a healthcare or benefits environment required;
• Proven experience serving as a strategic advisor to senior leadership and contributing to organizational planning, decision-making, and operational improvement initiatives required;
• Exceptional leadership, team development, and change management skills, with a demonstrated ability to build and lead high-performing, multidisciplinary teams required;
• Strong communication, presentation, and relationship management skills, including the ability to effectively communicate complex information to executive leadership, Boards, vendors, and other stakeholders required;
• Experience working in or supporting Taft-Hartley funds, union benefit funds, or other collectively bargained benefit environments preferred;
• Familiarity with healthcare price transparency requirements, Consolidated Appropriations Act (CAA) compensation disclosure requirements, pay integrity programs, and related vendor oversight practices preferred;
• Experience leading or supporting major vendor procurement initiatives, including TPA transitions, PBM evaluations, contract negotiations, or similar large-scale operational systems in a self-funded plan context preferred;
• Working knowledge of healthcare data structures, claims administration systems, benefits administration technology, analytics platforms, and related operational systems preferred;
• Demonstrated ability to balance strategic thinking with operational execution, drive accountability, manage competing priorities, and lead continuous improvement efforts required;
• Strong business judgement, problem-solving skills, and the ability to influence outcomes through collaboration, data-driven analysis, and effective stakeholder engagement required;
• Demonstrated commitment to member service, operational excellence, fiduciary responsibility, and organizational mission.

Soft Skills (Interpersonal Skills)

• Demonstrates operational excellence and strategic credibility.
• Understands the mechanics of how self-funded health plans work, how claims flow, how vendors are compensated, and where misaligned incentives can create risk.
• Holds vendors to high standards while maintaining productive business relationships, understanding the difference between constructive accountability and unnecessary adversarial approaches.
• Is as comfortable in a data discussion as in a member services review or vendor negotiation.
• Recognizes that data alone is not the goal—insight and action are—and builds teams, processes, and operational frameworks accordingly.
• Approaches plan document administration with appropriate care and attention.
• Leads people with clarity and purpose, creating an environment where team members understand what matters, why it matters, and how their work contributes to the Fund's mission.
• Serves as a trusted partner to the Managing Director, Health Fund, providing candid, practical, and well-grounded counsel that supports informed decision-making across the full scope of the Fund's operations.