Director of Plan Operations

📋 Description

• Lead a team of configuration specialists and analysts for onboarding and plan programming.
• Provide senior technical oversight for coding complex benefit plans in the claim system.
• Develop and execute strategy to improve plan ops efficiency, accuracy, and scalability.
• Oversee health plan administration, plan configuration, and related plan artifacts.
• Identify best practices to streamline workflows, boost performance, and reduce errors.
• Ensure compliance and risk management with ERISA, CMS, ACA, and HIPAA.

To be successful in this role, you'll need:

• 10+ years in health plan administration or benefits ops; at least 3 years hands-on technical experience in TPA/Payer settings focusing on coding, configuration, or claims system setup.
• Proficiency in enterprise benefit platforms (Facets, QNXT, HealthRules) and translating complex benefit logic into code.
• Deep understanding of health benefits, self-funded plans, TPA, and regulatory requirements.
• Proven track record of managing large-scale operations and driving process optimization.
• Strong analytical and problem-solving skills with a data-driven approach.
• Excellent communication and leadership; ability to collaborate across teams and influence stakeholders.

🎁 Benefits

• Mission-driven culture valuing innovation and collaboration in healthcare.
• Impactful projects shaping the future of our organization.
• Internal mobility, mentorship, and courses tailored to your interests.
• Flexible work arrangements and work-life balance.