Qualifications
Key Responsibilities
Lead comprehensive health plan operations for both self-funded and level-funded offerings.
Act as the main operational liaison for TPAs, PBMs, stop-loss providers, and other vendors.
Oversee the setup, implementation, renewals, and administration of health plans.
Ensure precise management of eligibility, claims operations, billing, and reconciliation processes.
Monitor vendor performance, proactively addressing any issues that arise.
Collaborate with internal teams across product development, finance, and client success.
Maintain regulatory compliance across all operations.
Identify and implement operational efficiencies and improvements.
Assist with reporting, audits, and data reviews.
Required Qualifications
5+ years of experience in health plan operations.
Experience working with TPAs or closely interacting with TPAs, PBMs, and stop-loss carriers.
Strong familiarity with self-funded and level-funded health plans.
Proven experience managing multiple vendor relationships.
In-depth knowledge of claims processing and benefits administration.
Excellent organizational and communication skills.
Preferred Qualifications
Experience in supporting plans for small to mid-sized employers.
Familiarity with contemporary health benefits models.
Background in startup or high-growth healthcare environments.
About the job
About Us
At Vitable, we asked ourselves, What if quality healthcare didn't have to come at a higher cost?
We created Vitable Health, a revolutionary health benefits platform that aims to improve healthcare accessibility for everyday workers. Our mission is to provide high-quality care to over 85 million uninsured and underinsured Americans. Unlike conventional options, our comprehensive suite of health benefits is designed with a focus on real people and their needs.
Vitable empowers businesses by simplifying the process of offering healthcare benefits to their employees, resulting in a better experience for team members and a more efficient solution for employers.
The Health Plan Operations Lead will be instrumental in overseeing and managing the daily operations of Vitable Health’s self-funded and level-funded health plans. This role is vital for ensuring smooth coordination with our external partners, including TPAs, PBMs, stop-loss carriers, and various insurance vendors, while delivering an exceptional experience for our employer clients and their members.
About Vitable Health
Vitable Health is dedicated to revolutionizing the healthcare experience for everyday workers by providing affordable and accessible health benefits. Our innovative platform is designed to meet the needs of over 85 million Americans without adequate healthcare coverage, empowering businesses to support their teams effectively.
