Health Plan Process and Operations Lead - (US-Anywhere in the USA)

Health Plan Process and Operations Lead - (US-Anywhere in the USA)

Minimum Education: Bachelors
Job Type: Full Time
Jobcode: CMEJA27

The business unit conceives, builds, and delivers end-to-end business process solutions. The portfolio of solutions includes high-volume traditional Business Process Outsourcing services as well as next-generation solutions that leverage automated, cloud-enabled delivery and innovative commercial models to provide clients with disruptive levels of savings and business value. 

Operations and Process: Provide direction to solution development and product management teams. Work closely with clients and internal teams to create detailed process models for BPaaS, understand upstream and down stream process linkages, establish underlying technology / platform linkages. Understand client's environment to create a roadmap for BPaaS solution development for health plan processes. 
Value Definition: Build E2E process models including technology & operations management, identify value drivers, create framework for measuring business impact and work closely with commercial and account teams to build financial models 
Collaboration: Work closely with consulting, BPO and technology teams to create and manage operations framework for BPaaS solutions.

12+ years of health plan operations experience, with 3+ years experience in health plan COO's direct staff OR 12+ years of health plan operational consulting experience 
Hands on experience across major health plan operations - Claims Management, Network Management, Operations, Medical Management, Membership Management, Sales & Marketing 
Well versed in regulatory compliance and standards, Government healthcare programs (Medicare and Medicaid) 
Knowledge of key platforms used in healthcare ecosystems, their challenges and opportunities 
Has a history of working with external technology partners 


Email resume in Word to TheBigGameHunter@cisny.com. Please include the job code for the position with your resume. 

NO RELOCATION. NO VISA TRANSFERS. NO OVERSEAS RESUMES. NO 3RD PARTIES. 

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