What are the responsibilities and job description for the VP, Health Plan Ops Administration position at Curative?
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
