Director of Plan Operations Plan Configuration

Director of Plan Operations - Plan Configuration

Collective Health is the leading health benefits platform that brings together medical, dental, vision, pharmacy, and program partners into an integrated solution that better enables employees and their families to understand, navigate, and pay for healthcare.

Job Description

At Collective Health, we're transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology, compassionate service, and world-class user experience design.

The Director, Plan Operations is a critical leadership role responsible for ensuring the seamless execution and operational performance of health plan administration at Collective Health. This individual will oversee plan operations strategy, execution, and optimization to drive efficiency, compliance, and an excellent client and member experience. The Director will collaborate cross-functionally with internal teams, external partners, and clients to ensure operational excellence in plan configuration, benefit administration, and issue resolution.

• Team Leadership & Development:
  Build and lead a high-performing team of system configuration specialists, plan design specialists, and analysts that support the onboarding and systemic plan programming for Collective Health's self-funded clients. Foster a culture of accountability, innovation, and continuous learning. Provide coaching, mentorship, and professional development opportunities to enhance team capabilities.
• Systemic Plan Programming & Technical Oversight:
  Drive operational excellence by providing senior technical oversight for the systematic programming (coding) of complex benefit plans within the claim adjudication system. Ensure configuration integrity and accuracy through comprehensive quality assurance processes, leveraging deep knowledge of third-party administration (TPA) systems.
• Plan Operations Strategy:
  Develop and execute a comprehensive strategy to enhance the efficiency, accuracy, and scalability of plan operations.
• Health Plan Administration:
  Oversee the implementation and ongoing management of client benefit plans, ensuring accuracy in plan configuration and plan artifacts such as Summary Plan Descriptions and Summary Benefits of Coverage. Process Optimization:
  Identify and implement best practices to streamline process workflows, optimize system performance, reduce errors, and improve turnaround times.
• Compliance &
  
  Risk Management:
  
  Work with internal departments such as Client Success, Compliance and Legal to ensure Plan Operations adheres to federal, state, and industry regulatory requirements, including ERISA, CMS, ACA, HIPAA, and other applicable laws. Stakeholder
  
  Collaboration:
  
  Partner with internal teams such as Product, Engineering, Client Success, and Customer Experience to enhance operational workflows and resolve complex issues. Collaborate with internal and external stakeholders on identifying and recommending benefit solutions and enhancements that will increase automation while meeting the needs of the Client.
• Performance Management:
  Establish and monitor key performance indicators (KPIs) to measure operational success, identify trends, and drive continuous improvement. Monitor system performance and quickly address issues related to configuration accuracy, plan language, claims adjudication and payment integrity activities.
• Client & Member Support:
  Ensure high-quality service delivery by addressing escalations, resolving operational challenges, and enhancing overall client satisfaction. Participate in current and prospective Client meetings with Client Success and Sales to communicate Plan Operations capabilities and performance, address concerns, make relevant and thoughtful recommendations, and to promote Collective Health in the marketplace.
• Technology & Automation:
  Work closely with Product and Engineering teams to implement technology-driven solutions that enhance the efficiency and accuracy of plan operations.

• 10+ years of experience in health plan administration, benefits operations, or a related field, with at least 3…