Director of Plan Operations

Our client is seeking a Director, Plan Operations Contractor who is responsible for ensuring the seamless execution and operational performance of health plan administration. This individual will oversee plan operations strategy, execution, and optimization to drive efficiency, compliance, and an excellent client and member experience. The Director will collaborate cross-functionally with internal teams, external partners, and clients to ensure operational excellence in plan configuration, benefit administration, and issue resolution.

What You'll Do

• Team Leadership & Development: Build and lead a high-performing team of system configuration specialists, plan design specialists, and analysts that support the onboarding and systemic plan programming for our self-funded clients. Foster a culture of accountability, innovation, and continuous learning. Provide coaching, mentorship, and professional development opportunities to enhance team capabilities.
• Systemic Plan Programming & Technical Oversight: Drive operational excellence by providing senior technical oversight for the systematic programming (coding) of complex benefit plans within the claim adjudication system. Ensure configuration integrity and accuracy through comprehensive quality assurance processes, leveraging deep knowledge of third-party administration (TPA) systems.
• Plan Operations Strategy: Develop and execute a comprehensive strategy to enhance the efficiency, accuracy, and scalability of plan operations.
• Health Plan Administration: Oversee the implementation and ongoing management of client benefit plans, ensuring accuracy in plan configuration and plan artifacts such as Summary Plan Descriptions and Summary Benefits of Coverage.
• Process Optimization: Identify and implement best practices to streamline process workflows, optimize system performance, reduce errors, and improve turnaround times.
• Compliance & Risk Management: Work with internal departments such as Client Success, Compliance and Legal to ensure Plan Operations adheres to federal, state, and industry regulatory requirements, including ERISA, CMS, ACA, HIPAA, and other applicable laws.
• Stakeholder Collaboration: Partner with internal teams such as Product, Engineering, Client Success, and Customer Experience to enhance operational workflows and resolve complex issues. Collaborate with internal and external stakeholders on identifying and recommending benefit solutions and enhancements that will increase automation while meeting the needs of the Client.
• Performance Management: Establish and monitor key performance indicators (KPIs) to measure operational success, identify trends, and drive continuous improvement. Monitor system performance and quickly address issues related to configuration accuracy, plan language, claims adjudication and payment integrity activities.
• Client & Member Support: Ensure high-quality service delivery by addressing escalations, resolving operational challenges, and enhancing overall client satisfaction. Participate in current and prospective Client meetings with Client Success and Sales to communicate Plan Operations capabilities and performance, address concerns, make relevant and thoughtful recommendations, and to promote our company in the marketplace.
• Technology & Automation: Work closely with Product and Engineering teams to implement technology-driven solutions that enhance the efficiency and accuracy of plan operations.
  
  

Qualifications

• 10 years of experience in health plan administration, benefits operations, or a related field, with at least 3 years of direct, hands-on technical experience in a Third-Party Administrator (TPA) or Payer setting focusing specifically on health plan coding, benefit configuration, or claims system setup.
• Mandatory proficiency in enterprise benefit platforms (e.g., Facets, QNXT, HealthRules, or similar TPA/Payer systems) and demonstrated expertise in translating complex benefit logic into accurate system code.
• Deep understanding of health benefits, self-funded plans, third-party administration, and regulatory requirements.
• Proven track record of managing large-scale operations, process optimization, and driving operational excellence.
• Strong analytical and problem-solving skills with a data-driven approach to decision-making.
• Excellent communication and leadership skills, with the ability to collaborate effectively across teams and influence key stakeholders.
• Experience in fast-paced, high-growth environments with a focus on continuous improvement, change management and innovation.
• Certified Coding Specialist, preferred but not required.
  
  

Compensation: $65 - $90 per hour

ID: 2673