VP, Advisory Operations

Job not on LinkedIn

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $290k - $318k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

🦅 H1B Visa Sponsor

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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

• Assess health plan core administration technology and operations across claims, enrollment, billing, and service • Identify root-cause drivers of cost, quality, and compliance gaps • Translate assessment findings into future-state roadmaps and business/technology blueprints positioning BPaaS as a path to improved outcomes • Quantify opportunities including cost takeout, service-level improvement, and error reduction • Build financial models covering ROI, IRR, and cost-benefit analysis • Define accountability across the advisory engagement lifecycle • Identify automation and AI-driven processes to streamline administrative tasks, reduce manual error, and strengthen transformation cases • Partner with Sales, solution, and delivery teams to translate roadmaps and business cases into executable operating models • Build and sustain relationships with client stakeholders from analyst to C-suite • Provide competitive intelligence and assess regulatory shifts, including CMS and state Medicaid, and platform capabilities • Report to the Chief Strategy Officer • Work across multiple time zones and use video technology in a hybrid or remote work environment • Travel as needed based on company requirements

🎯 Requirements

• 10+ years in health plan operations leadership or consulting focused on health plan operations, including claims, enrollment, billing, and member/provider service • Track record of managing teams, leading operational assessments, and translating findings into board or C-suite-ready recommendations • Experience evaluating in-flight or prior transformation initiatives • Working knowledge of core administrative platforms such as HealthRules Payer, Facets, QNXT, and QicLink • Financial modeling experience including outcome-based pricing, cost-benefit analysis, ROI, and IRR • Experience structuring and positioning transformation or BPaaS-style solutions for complex, multi-stakeholder deals • Demonstrated ability to build and grow relationships with operations leadership from director level through C-suite • Ability to manage ambiguity and determine which questions to ask when data is incomplete • Team leadership skills, including delegation and accountability for outcomes • May be required to undergo a pre-employment criminal background check

🏖️ Benefits

• Hybrid or remote work environment • May require travel dependent on company needs • Reasonable accommodations for individuals with disabilities • Equal opportunity and workforce diversity commitment