Vice President, Health Plan & Claims Operations

About the Company

Ambitious provider of health insurance solutions

Industry
Computer Software

Type
Privately Held, VC-backed

Founded
2013

Employees
501-1000

Funding
$200 million

Categories

• Business Intelligence
• Health Care
• SaaS
• Information Technology & Services
• Health
• Health Insurance
• Innovation
• Software
• Software Development & Design
• Startups
• Health Care Information Technology
• Health and Insurance
• Insurance
• Employee Management
• MedTech
• Cloud Solutions
• Healthcare
• Advanced Analytics
• Consulting
• Finance

Specialties

• Health Insurance and Health Benefits

Business Classifications

• B2C
• B2B
• SAAS

About the Role

The Company is seeking a VP of Health Plan and Claims Operations to lead and innovate in an industry that is fundamental to our well-being. The successful candidate will be at the forefront of a new era in healthcare, where members are empowered to make informed decisions in critical moments. This strategic leadership role involves overseeing the efficient operation of health plans, ensuring compliance, and delivering high-quality services. The VP will drive operational excellence, manage a large team, and foster a culture of continuous improvement. They will also be responsible for stakeholder engagement, budget planning, and risk management.Applicants must have a minimum of 15 years' of operations experience, with at least 5 years' in the healthcare industry, and a proven track record of success in senior leadership roles. Deep knowledge of claims processing systems, experience in large-scale operational transformations, and strong skills in process reengineering and change management are essential. The role demands exceptional leadership, communication, and the ability to translate complex concepts into measurable results. Familiarity with EDI platforms, benefits administration, and payer experience is a plus. The ideal candidate will be a strategic thinker, capable of driving innovation, and will embody the company's core values of learning, testing new ideas, and leading change without fear of failure.

Hiring Manager Title
SVP, Customer Experience

Travel Percent
Less than 10%

Functions

• Operations
• Medical Care/Hospital Administration