VP, Health Plan Ops Administration - Curative HR LLC

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. 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 and  scale growing health plan operations.

Essential Functions:

• Oversee health plan operations teams dedicated to provider load, plan configuration, claims, enrollment, eligibility, employer group and provider operations 

• Lead dynamic growth in provider and membership including new market expansion 

• Maximize health plan operations performance, driving efficiencies, creating market leading quality and operational administrative cost structure 

• Identify technology,  automation and artificial intelligence application for health plan back office functions for improved scalability and speed to market

• Recommend and implement cost savings initiatives in medical and admin costs

• Oversee health plan operations compliance with regulatory and state laws including new market entry

Responsibilities:

• Think creatively and scale growing health plan operations

• Drive OKR, KPI, quality and performance metrics resulting in superior health plan operations delivery in configurations, claims, employer group and provider support 

• Identify next level improvements to scale efficiently and effectively through AI and automation strategy development of both internal and external capabilities (vendor, BPO, claims edits)

• Lead market expansion plan roll-outs and benefit build-out across account management, marketing and customer service with interface into network, clinical, pharmacy, marketing and compliance teams

• Drive key operations team projects, provider cost savings initiatives, and cross organization initiatives representing the operations team 

• Oversee quality assurance programs, process documentation and training 

• Serve as key liaison for state regulatory and other audits 

• Form strong relationships with technology team to drive system and technology efforts for market leading operations

Please reach out if this describes your experience:

• Expertise in  employer group medical health coverage and health plan operations 

• Experience in building health operations teams and attracting key talent 

• Ability to oversee programmatic implementations, strategic planning, building processes and scaling operations 

• Experience in vendor contracting and performance management 

• Proven track record managing and building teams 

Qualifications

• 20+ years leadership experience of Employer Group Insurance Health Plan Operations and direct team oversight

• 10+ years  proven track record of health plan operations technology, strategy and process improvement deployment

• 10+ years of successful cost saving roll-outs 

• Bachelor’s Degree, MBA preferred 

• Remote position, with occasional travel