VP, Advisory Operations

VP Advisory Operations

You Are:

A Senior leader with deep expertise in health plan core administration technology and operations who leads advisory engagements assessing current-state  of health plan technology and operations across claims, enrollment, billing, and service - and builds the business case for health plans to move to HealthEdge's BPaaS operating model.

You know how to build trust with operations stakeholders at every level, and you're equally comfortable in a boardroom framing a transformation strategy and winning the trust - one that a CFO will fund and a COO will trust to execute.

Reports to: Chief Strategy Officer

The Opportunity:

• Actively engage and work with various team members in assessing health plan Core Administration and operations, identifying  root-cause drivers of cost, quality, and compliance gaps
• Review assessment findings into a future-state roadmap and business/technology blueprint that positions BPaaS as the path to improved efficiency, compliance, and operational outcomes
• Quantify the opportunity - cost takeout, service-level improvement, error reduction - and build the financial model (ROI, IRR, cost-benefit) that makes the business case credible to finance and operations leadership
• Define clear accountability across the advisory engagement lifecycle
• Identify where automation and AI-driven processes can streamline administrative tasks, reduce manual error, and strengthen the case for transformation
• Partner with Sales, solution and delivery teams to ensure the roadmap and business case translate cleanly into an executable operating model
• Build and sustain relationships with client stakeholders from analyst to C-suite, adapting the narrative and level of detail to the audience
• Bring outside-in perspective - competitive intelligence, regulatory shifts (CMS, state Medicaid), platform capabilities - to keep assessments grounded in what "good" looks like in the market today

What You Need:

• 10+ years in health plan operations leadership or consulting focused on health plan operations (claims, enrollment, billing, 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 - knowing how to diagnose why a program is stalled, underperforming, or ready to scale
• Working knowledge of core administrative platforms (e.g., HealthRules Payer, Facets, QNXT, QicLink) and how operating model choices affect cost-to-serve
• Financial modeling experience: outcome-based pricing, cost-benefit analysis, ROI/IRR, and the discipline to defend the numbers under scrutiny
• 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
• Comfort managing ambiguity - assessments rarely start with clean data, and part of the job is knowing which questions to ask to get there
• Team leadership: delegates well, holds people accountable to outcomes, and knows when to bring in a subject-matter specialist versus handling it personally

Geographic Responsibility:  Remote, US

Type of Employment: Full-time, permanent  

FLSA Classification (USA Only): Exempt 

Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job:  

• The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus.  

• Work across multiple time zones in a hybrid or remote work environment. 

• Long periods of time sitting and/or standing in front of a computer using video technology. 

• May require travel dependent on company needs.

The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990.  Candidates may be required to go through a pre-employment criminal background check. 

HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. 

#LI-Remote 

**The annual US base salary range for this position is $290,000 to $318,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.