Advance Your Career at Planstin
Located in Southern Utah, Planstin is at the forefront of benefits administration and business services. We simplify health insurance for employers and individuals, emphasizing cost-effectiveness and excellent service in a complex market. As our company grows, we're looking for talented individuals eager to progress in their careers.
About the role
Planstin is seeking an experienced Director of Operations that's ready to join an organization committed to creating inspired healthcare experiences! The Director of Operations will oversee the efficient administration of employee benefits programs within a Third-Party Administrator (TPA) model. This leadership role is integral in driving operational excellence, optimizing workflows, and ensuring compliance with industry regulations. A core focus will include streamlining processes around care coordination, cost containment strategies, and innovative healthcare solutions such as price shopping and Medicare reference-based pricing. The ideal candidate will have a proven ability to lead teams, implement technology-driven solutions, and enhance client / member satisfaction through process improvement and quality service delivery.
This position is based in St. George, Utah and will require full time work from the office.
What you"ll do
Operational Leadership
- Oversee day-to-day operations, including claims processing, benefits eligibility, enrollment, billing, and customer service.
- Develop and implement streamlined workflows to improve efficiency, reduce turnaround times, and minimize errors.
- Drive operational excellence in care coordination programs to empower patients and optimize healthcare cost management.
- Prepare systems and processes for organizational growth and scalability.
Compliance and Quality Assurance
Ensure adherence to all regulatory requirements, including ERISA, HIPAA, ACA, and Medicare guidelines.Partner with our Compliance team to conduct internal and external audits to maintain operational accuracy and compliance.Develop and maintain quality control measures for claims accuracy, payment timeliness, and service excellence.Strategic Process Optimization
Lead initiatives for fair-priced healthcare and other cost containment programs when providers do not accept fair pricing.Oversee the development and implementation of price shopping tools to assist members and clients in obtaining high-quality, cost-effective care.Identify and implement automation and technology improvements to enhance operational performance.Leadership and Team Management
Build, mentor, and lead high-performing teams, including claims, customer service, and care coordination staff.Monitor team performance through KPIs, ensuring operational goals and SLAs are met.Foster a collaborative work culture focused on continuous improvement and accountability.Financial Oversight
Monitor operational budgets, identifying opportunities for cost savings and improved efficiencies.Analyze claims data, cost trends, and operational reports to provide insights and recommendations for strategic decision-making.Client and Vendor Relationship Management
Act as a liaison with key stakeholders, including clients, vendors, and executive leadership, to ensure alignment and satisfaction.Monitor vendor performance and negotiate agreements to ensure quality and value for services provided.Collaborate with clients to address escalated operational issues and identify opportunities for process improvements.Qualifications
Education :Bachelor's degree in business administration, Healthcare Administration, or a related field. Master's degree preferred.
Experience :7-10 years of progressive experience in operations management, preferably within a TPA, benefits administration, or healthcare industry.
Experience leading programs related to care coordination, cost containment, and price shopping tools is highly desired.Proven track record in implementing Medicare reference-based pricing models.Skills :Strong leadership, project management, and process optimization skills.
Proficiency in benefits administration platforms and claims management systems.Exceptional analytical skills with the ability to interpret data and drive strategic decisions.Excellent interpersonal and communication skills for working with internal teams, clients, and vendors.Planstin"s Employee Benefits :
12 paid holidays plus 3 weeks of paid time off to balance work and life.Comprehensive insurance coverage including health, dental, vision, and accident plans tailored for your well-being.Invest in your future with a 401k plan backed by a solid 4% match from us.Enjoy the simplicity of weekly paychecks along with the perk of free snacks and regular lunches available onsite.Take your career to new heights with our dedicated training programs and a team environment that's all about support and growth.Build strong connections with colleagues at our frequent, fun team-building events.PI261436369
