Director of Operations - REMOTE

We are seeking a Director of Operations to lead the execution, performance, and continuous improvement of our core healthcare administration operations, including Administrative Services Only (ASO), Fully Insured (FI), ACA, and Stop‑Loss programs. This role is accountable for operational performance and execution. The Director of Operations will partner closely with the Technology, Finance, Compliance, Client Success, and Executive Leadership to support operational improvements, technology enablement, and organizational growth.

This role will provide operational expertise, ensure successful adoption of changes, and help sustain improvements across the organization. The Director will establish accountability, develop high‑performing teams, and ensure Reflect Health delivers reliable, scalable, and high‑quality service to clients and members. The ideal candidate is an experienced healthcare operations leader with deep expertise in self‑funded health plan administration, claims operations, ACA and Fully Insured products, stop‑loss administration, workforce leadership, and operational excellence.

• Own day‑to‑day operational execution across ASO, Fully Insured, ACA, and Stop‑Loss lines of business.
• Ensure operational teams deliver accurate, timely, compliant, and high‑quality services.
• Establish accountability across teams for service levels, productivity, quality, turnaround times, and client commitments.
• Manage operational priorities, workload capacity, resource allocation, and business performance.
• Ensure operational consistency across lines of business while managing the unique requirements of self‑funded ASO administration, Fully Insured plan operations, ACA workflows, and stop‑loss administration.
• Identify operational risks and opportunities while implementing solutions to improve performance, reliability, and client experience.
• Oversee execution of claims administration, eligibility coordination, billing support, stop‑loss administration, carrier collaboration, recoveries, and operational controls.
• Ensure claims and operational processes meet quality, compliance, financial, and service expectations.
• Monitor claims and stop‑loss performance, identify challenges, and implement corrective actions.
• Partner with internal teams and external stakeholders to resolve operational issues and improve outcomes.

• Recruit, develop, coach, and retain high‑performing operational teams and leaders.
• Establish clear performance expectations, leadership capabilities, and professional development opportunities.
• Build a culture of accountability, collaboration, continuous improvement, and customer‑focused execution.
• Develop organizational capacity to support business growth and evolving operational needs.
• Lead managers and teams through operational changes while ensuring engagement and adoption.

• Establish and manage operational KPIs, SLAs, quality standards, productivity measures, and service performance goals.
• Monitor operational results and implement improvement plans when performance expectations are not met.
• Maintain visibility into operational trends, risks, opportunities, and business outcomes.
• Provide leadership with insights and recommendations to improve operational effectiveness.

• Help identify opportunities to improve operational efficiency, reduce complexity, and enhance service delivery.
• Ensure operational teams successfully adopt and sustain new processes, technologies, and operating practices.
• Support continuous improvement efforts by identifying root causes, improving workflows, and strengthening operational discipline.

• Ensure compliance with applicable federal and state regulations, contractual obligations, internal policies, and healthcare industry requirements.
• Support audit readiness, quality assurance programs, and operational governance activities.
• Maintain appropriate operational controls and risk management practices.
• Ensure teams operate within established compliance and quality standards.