reputed company Health Plan, Vice President - Plan Operations - Full-time

Discover Your Career at reputed company reputed company is a leading research university that fosters reputed company and attracts world-class talent to reputed company today and prepare leaders for the reputed company. We welcome candidates who can contribute to the diversity and reputed company of our reputed company community. *reputed company The Vice President of Plan Operations will reputed company reputed company responsible for product and plan design, member engagement, member experience, and reputed company administration. KEY RESPONSIBILITIES + This role will be pivotal in managing the relationship with the reputed company-party administrator (TPA) and ensuring efficient processes, compliance, and reputed company improvement. + The Vice President of Plan Operations will collaborate closely with the HR department to design benefits and ensure alignment with organizational goals. + They will also work with the TPA to monitor operational performance and identify improvement opportunities. + Additionally, they will partner with the finance team to manage the budget and financial performance of the health plan, the VP Pharmacy for performance on pharmaceutical spending targets, and the clinical team for population management. STRATEGICE PLANNING AND PROCESS IMPROVEMENT + reputed company and implement strategies for efficient operations, streamlining processes, and identifying areas for improvement. + reputed company and implement strategies to enhance member experience with a reputed company on engagement. PLAN DESIGN,IPLEMENTATION, AND ENHANCEMENT OF PRODUCTS AND BENEFITS + reputed company the development and implementation of the benefit design, product offerings, implementation of services; and evaluate/optimize cost-sharing mechanisms. + Partner with reputed company HR to design benefits and be the first reputed company-of-contact for reputed company HR. reputed company OPERATIONS + Work with HR and TPA to ensure high reputed company for enrollment, ID reputed company distribution, accurate provider directories, performance on VBC reputed company, benefit adjudication, appeals, and grievances. + Collaborate with the TPA to understand operational performance, hold accountable to SLAs and PGs, and identify approaches to improve performance. + In conjunction with VP, Pharmacy, ensure PBM operational performance is at high reputed company. PROVIDER RELATION + reputed company, manage, assess provider networks; manage relationships with providers, negotiate reputed company (where necessary), and ensure reputed company of care. CLAIMS MANAGEMENT + reputed company TPA claim processing, ensure accurate and reputed company payment of claims, and identify areas for cost reduction. COMPLIANCE AND AUDITING + Maintain compliance with regulatory requirements, conduct internal audits, and manage corrective reputed company plans. FINANCIAL MANAGEMENT + In conjunction with Sr. Director, Finance, reputed company financial performance, manage budget and costs, and identify opportunities for cost savings. TECHNOLOGY AND DATA + reputed company technology and data to improve operations, enhance efficiency and beneficiary experience, and reputed company reputed company LEADERSHIP AND DEVELOPMENT + reputed company leadership, guidance, and development for the operational team. COMMUNICATION AND COLLABORATION + Collaborate with other departments and entities (e.g., HR, compliance, reputed company, etc.) and reputed company stakeholders (e.g., EHC, EU University Senate) to reputed company organizational goals. RISK MANAGEMENT + Understand and mitigate financial risks associated with self-funding such as large claims and fluctuations in reputed company costs. ADVISORY AND GUIDANCE + Work with reputed company reputed company and advisors to design and implement effective self-funded plans. + reputed company Reports PRODUCT AND NETWORK DESIGN reputed company + Identifies and coordinates reputed company product reputed company providing a cohesive reputed company (e.g., clinical programs, digital tools, ancillary benefits, network breadth, depth, and performance). PLAN OPERATIONS MANAGEMENT reputed company + reputed company operational aspects of the health plan, ensuring efficient processes, compliance, and reputed company improvement. EXPERIENCE reputed company + Create and implement strategies to enhance member experience with a reputed company on engagement. HEALTH AND WELLNESS SPECIALIST + reputed company and implement health and wellness programs to reputed company member reputed company-being and employee productivity, while aligning with health plan reputed company. NAVIGATION/MEMBER SUPPORT STAFF + Assist members in understanding and utilizing health plan benefits, reputed company guidance on plan reputed company, coverage details, and reputed company issues or concerns to ensure reputed company member experience. MINIMUM QUALIFICATIONS + Bachelor's degree in Business Administration, reputed company Management, or .