Health Plan Operations Lead
✨ AI Summary
Vitable Health is seeking a Health Plan Operations Lead to manage the daily operations of its self-funded and level-funded health plans. This remote role plays a crucial part in ensuring effective collaboration with external partners like TPAs, PBMs, and insurance vendors, while delivering an outstanding experience for both employer clients and members.
Main Responsibilities
- Oversee comprehensive operations for self-funded and level-funded health plans.
- Act as the main operational liaison for TPAs, PBMs, and related vendors.
- Manage plan setup, implementation, renewals, and administration processes.
- Ensure accuracy in eligibility, claims processing, billing, and reconciliation.
- Monitor vendor effectiveness and troubleshoot issues proactively.
- Work collaboratively with internal teams, including product, finance, and client success.
- Maintain compliance with regulations and identify areas for operational improvement.
- Support reporting, audits, and data assessments.
Qualifications
- Minimum of 5 years of experience in health plan operations.
- Familiarity with TPAs, PBMs, and stop-loss carriers.
- Strong knowledge of self-funded and level-funded plans.
- Proficient in managing vendor relationships and claims processing.
- Excellent organizational and communication skills.
Preferred Qualifications
- Experience with small to mid-sized employer plans.
- Knowledge of innovative health benefits models.
- Background in startup or high-growth healthcare environments.
Benefits
Vitable offers a comprehensive benefits package, including full medical coverage, dental and vision plans, a 401(k), unlimited PTO, and a remote-first culture.
