Health Plan Operations Manager

Job Summary

A company is looking for a Health Plan Operations Lead to oversee health plan operations and vendor coordination.

Key Responsibilities

• Lead end-to-end health plan operations for self-funded and level-funded plans
• Serve as the primary operational contact for TPAs, PBMs, stop-loss providers, and vendors
• Ensure accurate eligibility, claims operations, billing, and reconciliation

Required Qualifications

• 5+ years experience in health plan operations
• Experience working at a TPA or closely with TPAs, PBMs, and stop-loss carriers
• Strong understanding of self-funded and level-funded plans
• Experience managing multiple vendor relationships
• Knowledge of claims processing and benefits administration