Operations Lead

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

Under the direction of the Lead Director, Health Plan Market Operations, the Operations Lead is responsible for overseeing day-to-day health plan operations, ensuring operational readiness, regulatory compliance, and effective execution of strategic initiatives across Integrated Plans.

Responsibilities

• Provide operational oversight and coordination across health plan functional areas to support efficient and compliant service delivery.
• Lead cross-functional efforts to identify, prioritize, and resolve operational issues affecting members, providers, regulators, and business partners.
• Establish and maintain operational readiness processes for annual implementation activities, including product launches, benefit changes, regulatory requirements, and market expansions.
• Monitor operational performance, service levels, regulatory requirements, and business outcomes, escalating risks and developing remediation strategies as needed.
• Develop and maintain operational workplans, readiness trackers, risk logs, and reporting tools to support leadership visibility and accountability.
• Drive issue management processes, facilitating cross-functional discussions to identify root causes, implement corrective actions, and prevent future operational impacts.
• Partner with enterprise shared services teams, including claims, enrollment, member services, care management, provider services, and compliance, to ensure seamless operational execution.
• Support state, CMS, NCQA, and internal audit activities through coordination of documentation, evidence collection, remediation planning, and progress reporting.
• Monitor regulatory changes and contract requirements to ensure timely operational implementation and ongoing compliance.
• Develop executive-level reporting and presentations that communicate operational performance, readiness status, risks, issues, and mitigation plans.
• Act as a trusted operational subject matter expert and primary point of contact for internal and stakeholders regarding Integrated Plan operations.
• Support financial remediation efforts by identifying operational drivers of financial performance and partnering with business owners to implement corrective actions.
• Maintain strong relationships with market leaders, executive leadership, enterprise partners, regulators, and community stakeholders to support business objectives and member outcomes.
• Provide operational leadership during critical incidents, readiness events, and regulatory escalations, coordinating action plans and ensuring timely resolution.
• Support additional Health Plan Market Operations activities and provide cross-functional support as business needs require.

Required Qualifications

• 7+ years of healthcare operations, managed care, health plan administration, regulatory compliance, or related experience.
• 5+ years of experience leading cross-functional operational initiatives and driving organizational outcomes.
• Experience supporting Dual Eligible Special Needs Plans (D-SNP), FIDE, HIDE, MLTSS.
• Strong knowledge of CMS, state regulatory requirements, health plan operations, and audit readiness processes.
• Experience developing executive-level reports, presentations, and operational performance dashboards.
• Demonstrated ability to influence stakeholders and drive issue resolution without direct authority.
• Experience leading operational readiness, implementation, or transformation initiatives.
• Strong analytical, problem-solving, and decision-making skills.
• Excellent verbal, written, and presentation communication skills.
• Advanced proficiency in Microsoft Excel, PowerPoint, and data analysis tools.
• Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Operations Management, or related field, or equivalent combination of education and experience.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.

Pay Range

$75,400.00 - $199,144.00