Senior Vice President, Health Plan Operations

4 days ago

South Bend, Indiana, United States PacificSource Full time
About the Role

PacificSource is seeking a highly experienced Senior Vice President, Health Plan Operations to join our team. As a key member of our Senior Leadership Team, you will play a critical role in developing and implementing our company's strategic and business plans.

Key Responsibilities
  • Oversee the development and implementation of operational processes, member and provider touchpoints, and operating systems to support health risk identification and management, operational excellence, compliance, and employee development and satisfaction.
  • Partner closely with other senior leaders to ensure our operations meet customer needs and expectations and meet or exceed market competitive standards.
  • Responsible for key functions, including claims processing, payment integrity, customer service, product configuration and implementation, membership, enrollment and billing, business continuity, quality assurance, grievance, operations training, performance measurement, project prioritization and operational capacity planning.
  • Ensure company processes are compliant with regulatory and legal requirements across multiple states and lines of business, and ensure systems and processes are operating in accordance with products sold, contractual commitments, performance guarantees, and business policies.
  • Develop and achieve business unit production and financial targets and requirements based on Line of Business market requirements, federal and state regulatory requirements, contractual agreements, and enterprise budgets.
Requirements
  • Minimum 10 years of demonstrated executive level Health Plan Operations experience.
  • Baccalaureate degree in business, finance, or management required.
  • Expert knowledge of insurance industry procedures and protocols, benchmarking techniques, performance improvement, and general management skills.
  • Excellent analytical skills and knowledge of management techniques.
  • Ability to visualize and implement general plans to specific assigned objectives.
About PacificSource

PacificSource is an equal opportunity employer committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected, and responded to in ways that fully develop and utilize each person's talents and strengths.

We value the diversity of the people we hire and serve, and we are committed to making a positive impact in our communities.

We encourage creativity, innovation, and the pursuit of excellence, and we are dedicated to advancing social justice, equity, diversity, and inclusion in our workplace, the healthcare system, and community.

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