Director of Health Plan Operations

Kforce Finance and Accounting

2020-10-12 20:12:34

Job location Miami, Florida, United States

Job type: fulltime

Job industry: Executive Positions

Job description


Kforce has a client seeking a Director of Health Plan Operations in Miami, FL. Summary: The Director of Health Plan Operations is responsible for overseeing the functions of client's Health Plan Operations (HPO) department and Business Processing Outsourcing (BPO) services including, claims processing, utilization management, enrollment services, configuration, premium billing, quality assurance, and electronic data interchange for Client's Health Plan clients and partners; evaluates, analyzes, creates processes, and reports on key performance indicators (KPIs) and service level agreements (SLAs), expenses, and value creation; acts as a key contact, bridging communication and process rollouts between Client and our providers, outsourcing and automation partners. Responsibilities:
  • Creates value and capacity across multiple business units through by leveraging internal teams, third-party providers, outsourcing, process optimization, and automation
  • Ensures claims processing, encounters, billing, utilization management, appeals, enrollment services, configuration, quality assurance, electronic data interchange, and all other functions of the team are accurately and timely performed
  • Sets relevant and meaningful Service Level Agreement (SLA) goals for each responsibility outsourced and/or automated, and actively manages our provider partners to meet and exceeding those goals
  • Creates and develops meaningful and measurable KPI targets for the team, and ensures set targets are met or exceeded
  • Presents monthly, quarterly, and annual metrics dashboards for all internal and outsourced services related to Health Plan Operations functions and deliverables

Job Requirements:


Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

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