Healthcare Operations Strategy Consultant

Job not on LinkedIn

🕒 May 28

🇺🇸 United States – Remote

💵 $135k - $155k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 34%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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HealthEdge

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2005

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

HealthEdge is a company that specializes in providing advanced solutions for healthcare payers through its HealthRules Solutions Suite. This suite includes a comprehensive digital claims administration processing system, care management workflow solutions, and payment integrity solutions, which aim to enhance operational efficiency and improve quality of care for health plans. By leveraging integrated technology and automation, HealthEdge helps health plans eliminate data silos, increase payment accuracy, and elevate member experience, thereby transforming the healthcare landscape for better collaboration and accessibility.

📋 Description

• Lead service model design and solution blueprinting for health plan Core Administration transformation initiatives. • Assess current-state operations on legacy platforms and define transition pathways to BPaaS delivery models on the HealthEdge ecosystem. • Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations. • Define how BPaaS service layers connect across the health plan ecosystem. • Identify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration into operational service models. • Develop business cases demonstrating cost reduction, operational efficiency, scalability, and compliance improvements. • Conduct current-state assessments of Core Admin operations, staffing models, and process maturity. • Create modernization roadmaps and platform transition strategies grounded in operational realities and health plan business priorities.

🎯 Requirements

• 5+ years in health plan operations, Core Administration, or healthcare BPaaS strategy. • Deep operational expertise across one or more Core Admin domains: claims, enrollment, billing, benefits administration, UM, A&G, provider, and member services. • Prior consulting, managed services, or advisory experience with a health plan, SI, or BPaaS vendor. • Proven ability to assess operational models and design future-state BPaaS service blueprints. • Strong familiarity with Core Admin platforms (HealthRules Payer, Facets, QNXT, QicLink, Javelina, or equivalent).

🏖️ Benefits

• Health insurance • 401(k) matching • Paid time off • Remote work options • Professional development