Health Insurance Operations Manager manages and maintains daily health insurance operations in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility. Handles and settles complicated customer service issues which can not be resolved by lower level staff. Being a Health Insurance Operations Manager monitors performance of each service area. Requires a bachelor's degree or its equivalent. Additionally, Health Insurance Operations Manager typically reports to senior management or Director. The Health Insurance Operations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Health Insurance Operations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
About myPlace Health
myPlace Health was founded in 2021 by mission-aligned healthcare leaders and organizations that are committed to drastically improving health outcomes, quality and experience for vulnerable older adults and frail seniors. We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish.
Our mission is simple: to enable older adults to live the independent lives they deserve. We pursue this mission through our myPlace PACE (Program of All-Inclusive Care for the Elderly) model, which provides seamless primary care, integrated health plan coverage, personalized social engagement, and customized services delivered in the participant’s preferred place.
myPlace Health is building a mission-driven team that shares our passion for redefining the way older adults experience care as they “age in place” in the community. This is a unique opportunity to take on one of our country’s most challenging healthcare problems and join a fast-growing, dynamic team as we prepare to scale our mission to serve more markets.
About this Role
This is an extraordinary opportunity for a mission-driven leader to play an integral role in building and leading health plan operations in a dynamic, integrated care delivery startup. This teammate will report to the Sr. Director of Health Plan Operations and will be responsible for the management and oversight of functions that include but are not limited to: TPA management/oversight (claims), utilization management, risk adjustment, and PBM oversight, and pharmacy services vendor oversight.
As one of the inaugural members of our Health Plan leadership team, this teammate will set the tone in how we maintain sound, compliant financial management practices and efficient health plan operations that enable us to scale our model effectively and responsibly. Most importantly, this teammate will be empowered to think strategically across nearly all facets and modalities of healthcare delivery in support of our effort to redefine the way older adults experience care as they age in place in their homes and communities.
The final leveling of this role will be Sr. Manager or Director, dependent on the selected candidates relevant past experience, competencies, and level of autonomy with which the selected candidate can operate.
\nYour Application
Please submit your resume/CV and a short message that explains why you are interested in this role..
Our Commitment to Diversity, Equity and Inclusion
At myPlace Health, we value the diversity of our team members, and we are committed to building a culture of inclusion and belonging. We pride ourselves to be an equal opportunity employer. People seeking employment at myPlace Health are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
COVID-19 Vaccination Policy
At myPlace Health, we provide safe and high-quality care to our participants. To achieve this, we have implemented a strongly recommended vaccination policy to keep both our team members and participants safe as an essential requirement of this role. Medical and religious exemptions can be granted based upon review of proper documentation. We adhere to all federal, state, and local regulations by obtaining necessary proof of vaccination prior to employment.
Beware of Scams and Fraud
Please beware of scams that solicit interviews or promote jobs for opportunities that are not listed on our website or are not directly related to a job you applied for yourself. Please be advised that myPlace Health will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/..
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