Eligibility is one of the highest-priority enterprise processes and is at the center of both plan administration and Collective Health’s value proposition.  

As the VP Eligibility & Payment Operations you will report into our SVP, Customer Experience and lead the operations teams responsible for Eligibility, ID Cards, Payments and Stop Loss.  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. 

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. This role is responsible for the development, scaling, and execution of the Eligibility, Card Operations, Payments and Stop Loss capabilities, focused on simplifying end-to-end customer experiences and business processes in a scalable way, while reducing operational expenses and risks leveraging a modern technology stack. 

What you’ll do:

• Evaluate Collective Health’s role in Health Benefits & Non-medical Eligibility and build the next generation of eligibility at Collective Health
• Drive innovation in Eligibility to better serve our clients/members and reduce our cost to deliver our differentiated service partnering with Product and Engineering
• Build a plan that balances the needs of our clients, unique positioning of our product strategy, and long-term value Collective Health can deliver
• Identify both near-term and long-term strategic opportunities that span customer experience, operational processes, technology, automation, and risk management
• Develop and deliver success measurements and sustainability plans
• Develop and execute an organization-wide change management plan with your own team,  with key stakeholders, and across the organization
• Lead broad, multidisciplinary stakeholder management
• Lead the Collective Health Eligibility, Card, Payment and Stop Loss Operations teams
• Responsible for leading daily operations
• Oversee the daily receipt and processing of eligibility files and invoices with partners including the process for troubleshooting and resolving daily processing edits and research
• Manage and oversee daily operations for integrations with payment vendors and banks
• Accountable for driving results that meet performance KPIs

Operational Excellence:

• Drive execution against strategic priorities with urgency, prioritize and sequence strategic transformation of Eligibility to realize opportunities identified, pivoting as needed.
• 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:
• At least 15 years of Operations experience with at least 5 years in Healthcare industry
• At least 10 years of steadily advancing leadership roles and a proven track record of success
• Strong understanding of eligibility processing from start to finish preferred
• Experience in operational excellence, Lean, process reengineering and/or large-scale transformation
• Experience taking a design and systems thinking approach
• Proven track-record of leading major transitions to a new technologies, processes, and workflows, including any commercial implications
• 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 either our Lehi, UT or Plano, TX office. Hybrid employees are expected to be in the office three days per week (Plano, TX) or two days per week (Lehi, UT).#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.