We all depend on healthcare throughout our lifetimes, for ourselves, and our families and friends, but it is notoriously difficult to navigate and understand. As an industry that comprises 20% of the US economy we think healthcare should work better for all of us. At Collective Health we believe it’s time for a new day in healthcare where as members we are informed and empowered to make the right care choices when the decisions are urgent and critical. 

As the VP, Claims and Plan Operations you will report into our SVP, Customer Experience and lead the operations teams responsible for Claims Operations, Member Claims, Payment Integrity and Health Plan Operations.  The VP of Health Plan & Claims Operations ensures that the health plans operate efficiently, meet compliance standards, and deliver high-quality services to clients. 

This position requires a strategic thinker with a deep understanding of health care systems and claims administration, as well as the ability to manage large teams and complex operations. You will be responsible for the development, scaling, and execution of Claims and Health Plan operations focused on simplifying end-to-end customer experiences and business processes, while reducing operational expenses and risks leveraging a modern technology stack.  We’re on an undeniable growth path and looking for a senior leader to help us continue to raise the bar on enabling modern healthcare.

What you’ll do:

Strategic Leadership and Innovation:

• Lead a multidisciplinary team encompassing Member Claims, Systems, Plan Policies, Plan Partners and Payment Integrity, you will collaborate closely with cross-functional teams to ensure the seamless operation of our claims administration processes and uphold the highest standards of quality and compliance. 
• Drive innovation in Claims and Plan Operations  to better serve our clients/members and reduce our cost to deliver our differentiated service partnering with Product and Engineering
• Identify both near-term and long-term strategic opportunities that span customer experience, operational processes, technology, automation, and risk management
• Drive execution against strategic priorities with urgency, prioritize and sequence strategic transformation to realize opportunities identified, pivoting as needed.
• Partner with Product and Engineering leadership to execute short and long term strategies enabled by technology
• Develop and deliver success measurements and sustainability plans
• Lead broad, multidisciplinary stakeholder management
• Lead initiatives to ensure payment accuracy, prevent fraud, waste, and abuse, and implement cost containment strategies to optimize claims expenditures while maintaining high-quality care delivery.

Operational Excellence:

• Drive initiatives focused on operational improvements and technological advancements that increase efficiency and enhance client satisfaction.
• Drive a culture of continuous improvement.
• Ensure the effective daily operation of Claims functions.

Risk Management and Compliance:

• Implement robust governance structures to manage data exchanges and compliance with state and federal regulatory standards.
• Lead initiatives to mitigate operational risks and ensure compliance with healthcare regulations and standards.

Team Leadership and Development:

• Manage a large team across various operational functions and locations, focusing on performance management, professional development, and maintaining a high-engagement culture.
• Develop the next generation of Collective Health leaders
• Foster a collaborative environment that values continuous improvement and high performance.

Stakeholder Engagement:

• Collaborate with senior leaders across Product, Engineering, and Customer Experience to align operations with overall business objectives.
• Build strong relationships with external partners and stakeholders to enhance service delivery and operational efficiency.

Budget Planning and Management:

• Strategic financial planning by overseeing budget development and management processes. 
• Leverage expertise to optimize resource allocation, identify cost-saving opportunities, and ensure alignment with organizational goals

Your Skills Include:

• A minimum of 15 years of operations experience with at least 5 years in the healthcare industry.
• At least 10 years in senior leadership roles leading large teams in a highly matrixed or complex environment with a track record of operational success and team leadership.
• Deep working knowledge of claims processing systems.
• Experience in leading large-scale operational transformations and technology transitions.
• Strong capability in process reengineering, applying Lean methodologies, and driving large-scale change management initiatives.
• Exceptional leadership and communication skills, capable of leading, developing and growing  diverse teams and working effectively across organizational boundaries.
• Demonstrated ability to dive deep into operational details while maintaining a strategic view.
• Ability to think strategically beyond current capabilities and drive that strategy to results
• Eager to dive deep into details and personally drive results in complex and challenging environments in a start-up style environment
• Ability to translate complex technical and operational concepts into measurable results, and vice versa.
• Familiarity with EDI platforms and data flows.
• Benefits administration and/or Payer experience.
• Strong communications and leadership skills, while acting as a role model and coaching team members in Collective Health’s core values.
• Ability to establish oneself as a peer and trusted partner, building strong cross-functional relationships, working across and break down organizational silos
• Sets aggressive goals and is accountable for continuously driving improved performance, leading change and ensuring high standards
• Courageously learns and tests new ideas, building a culture without fear of failure
• Impeccable judgment and ability to make sound decisions in a fast-paced, dynamic setting.

Pay Transparency Statement:

This is a hybrid position based out of our offices: San Francisco, CA, Plano, TX, or Lehi, UT. Hybrid employees are expected to be in the office three days per week (Plano, TX) or two days per week (all other locations). #LI-hybrid

The actual pay rate offered within the range will depend on factors including geographic location, qualifications, experience, and internal equity. In addition to the salary, you will be eligible for stock options and benefits like health insurance, 401k, and paid time off. Learn more about our benefits at https://jobs.collectivehealth.com/#benefits.