VP, Health Plan Operations

2 weeks ago

Austin, United States Curative HR LLC Full time
Curative is reimagining health insurance - with $0 out of pocket costs and by reducing barriers to people seeking care. Help us create a better healthcare experience for our members by making it easy & intuitive for them to access the care they need. We believe in a clear, simple health plan that allows our members to get zero-cost in-network care anytime they need it. We want to put healthcare back in the hands of the patient and clinicians, with a focus on preventative care.

Essential Functions:

  • Lead capacity planning across health plan operations to scale for dynamic membership growth while maximizing performance, driving efficiencies, and creating market leading operational administrative cost structure
  • Direct vendor strategy to maximize health plan operations capabilities and cost structure including contract negotiations and oversight of team leading implementation and process build-out with integration to other teams (i.e. claims payment optimization, ID cards, etc)
  • Participate in due diligence for acquisition candidates from health plan operational capabilities, financial impacts, and organizational integration
  • Oversee team members driving process design, training, policies and procedures to promote scalability, support system build-outs and identify leading market service delivery capabilities
  • Partner with teams to recommend and implement medical cost savings initiatives and population health initiatives across health plan operations
  • Oversee Health Plan Ops Manager and continue to build out health plan ops team as we develop end to end workflows to develop infrastructure to deliver on high membership growth with a focus on superior customer, provider, and member experience

Responsibilities:

  • Curative is rapidly growing, and is raising the bar in what people expect from their health plan. We're looking for someone who can think creatively, has attention to detail, and can help us scale an aggressively growing business by making health plan operations are onboarded quickly and accurately.
  • Create capacity plan across health plan operations including cost benefit analysis and budgeting
  • Drive KPI, quality and performance metrics resulting in superior health plan operations delivery
  • Identify how we can improve our delivery through both internal capabilites and vendors (fraud, waste, & abuse, appeals and grievances, etc)
  • Lead competitive benefit and member service strategy and build-out across claims, account management, marketing and customer service with interface into network, clinical, pharmacy, marketing and compliance teams
  • Establish key OKR metrics and tracking across internal and vendor functions
  • Lead and participate in key operations team projects, medical cost savings initiatives, and cross organization initiatives representing the operations team

Please reach out if this describes your experience:

  • Knowledge of medical health coverage and health plan operations
  • Experience in modeling and planning for a dynamic growth agenda
  • Skilled in budgeting and financial analysis to maximize operational cost structure
  • Ability to oversee programmatic implementations, building processes and scaling operations
  • Experience in vendor contracting and performance management
  • Proven track record managing teams and driving process improvement initiatives

Bonus points for

  • M&A due diligence experience
  • A strong desire to make healthcare better, to be part of a big change in the health insurance market

Qualifications

  • 10+ years leadership experience within Health Insurance environment
  • Bachelor's Degree, MBA preferred
  • Remote position, with occasional travel

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