Health Plan Administrator and Chief Operating Officer

Executive Director Of Finance

This position has executive-level responsibility for the administration, financial management, regulatory compliance, and ongoing operation of a self-funded cooperative health insurance plan providing benefits to active employees, retirees, and eligible dependent of participating school districts and BOCES. The incumbent provides leadership and oversight of Plan operations; coordinates relationships with third-party administrators, consultants, carriers, service providers, and other contracted partners; and serves as a primary resource to participating employers while supporting the Plan's financial sustainability and delivery of high-quality benefits.

Work is performed under the general supervision of the Executive Director of Finance, with significant independent judgement and responsibility for the day-to-day administration of the Plan. The incumbent works closely with the Health Plan Board of Directors and Executive Committee, providing information, analysis, recommendations, and administrative support to facilitate effective governance and informed decision-making.

Typical Work

Activities:

• Provides executive leadership and directs the overall administration, financial management and day-to-day operations of the self-funded cooperative health plan serving participating school districts and BOCES.
• Develops, administers, and monitors the Plan's annual operating budget and overall financial operations, including revenues, expenditures, claims costs, cash flow, reserves, and other financial indicators; develops financial forecasts and recommends premium rates and other actions necessary to maintain the Plan's long-term financial stability.
• Oversees the Plan's banking, investments, cash management, and claims-funding activities and ensures appropriate internal controls and sound fiscal management practices.
• Prepares and presents periodic financial statements, budget status reports, claims analyses, performance reports, projections and other financial and operational information to the Board of Directors and appropriate committees.
• Directs and coordinates the preparation of regulatory financial statements, reports, filings, and other required submissions and serves as a principal liaison with federal and state regulatory agencies, including responding to inquiries, examinations and findings and implementing required corrective actions.
• Monitors and interprets federal and state laws, regulations and industry developments affecting the Plan and recommends appropriate changes to policies, procedures, coverage, plan design, and operations to maintain compliance and effectively manage risk.
• Oversees compliance activities associated with health plan operations, including applicable privacy, security, health care reform and other regulatory requirements, and coordinates development and maintenance of required policies, procedures, training, and reporting.
• Serves as the primary executive liaison among the Plan, participating employers, third-party administrators, consultants, legal counsel, auditors, financial institutions, insurance carriers, vCISO, and other professional service providers; monitors contractor performance and ensures effective coordination of services.
• Reviews and analyzes claims experience, utilization, demographic and financial data, insurance coverage, stop-loss arrangements, and other Plan performance indicators and develops recommendations to control costs, manage risk, improve services, and maintain the financial sustainability of the Plan.
• Provides guidance and assistance to participating school districts and Plan members regarding coverage, benefits and Plan provisions and facilitates resolution of complex coverage, enrollment, claims, and service issues in coordination with appropriate administrators and service providers.
• Coordinates the activities of the Board of Directors and Executive and other committees, including development of meeting agendas, preparation and presentation of supporting information and recommendations, and implementation of actions authorized by the governing body.
• Develops and maintains effective communications with participating employers, Plan members and other stakeholders regarding Plan operations, benefits, regulatory developments, financial performance, and other matters affecting the Plan.
• Develops and implements long-range strategic and operational plans; evaluates opportunities for changes in plan design, coverage arrangements, service delivery, wellness initiatives, and other strategies designed to improve member services and the Plan's operational and financial performance.
• Oversees the development, maintenance and periodic review of Plan documents, policies, procedures, business continuity and disaster response plans, cybersecurity practices, and other administrative and operational controls.
• Coordinates annual independent audits, actuarial studies, regulatory examinations, and other external reviews and ensures timely response to…