Vice President of Operations

Job Summary

Seeking a seasoned and strategic Vice President of Operations to lead and optimize operational performance within a Third-Party Administration (TPA) organization. This executive role is pivotal in overseeing health benefits administration, operational infrastructure, compliance, client service delivery, and cross-functional performance. The successful candidate will ensure scalable growth, regulatory compliance, and exceptional client outcomes.

Compensation Package

• Base Salary: $130,000 - $160,000 per year
• Type: Permanent, full-time position
• Work Schedule: 5 days per week onsite

Responsibilities

• Provide executive leadership and strategic oversight for all operational functions, including claims administration, eligibility, billing, customer service, and compliance.
• Drive operational excellence through process optimization, performance metrics, automation, and system enhancements.
• Oversee medical claims operations, ensuring accuracy, timeliness, compliance, and cost containment.
• Partner with underwriting, finance, and sales teams to support pricing strategies, risk evaluation, and client profitability.
• Maintain a strong working knowledge of carrier relationships, stop-loss arrangements, and network contracting.
• Ensure compliance with ERISA, HIPAA, ACA, FLSA, and applicable state and federal regulations.
• Lead and mentor department leaders, fostering a high-performance, accountable, and client-focused culture.
• Develop KPIs and reporting dashboards to monitor operational effectiveness and financial performance.
• Identify and implement scalable infrastructure to support organizational growth.
• Serve as an executive liaison with key clients, brokers, carriers, and vendor partners.

Qualifications/Requirements

Required:

• 10+ years of executive leadership experience in Third-Party Administration (TPA) within health benefits.
• Demonstrated experience overseeing health plan operations and claims administration.
• Strong knowledge of self-funded health plans, trust structures, and plan funding models.
• Proven ability to manage multi-department operations and drive measurable performance improvements.
• Experience with regulatory compliance and risk management in employee benefits administration.
• Exceptional leadership, communication, and organizational skills.

Preferred:

• Medical claims adjudication experience.
• Direct experience working for or closely with a medical carrier.
• Underwriting experience, including risk analysis and plan pricing support.
• Experience with benefits administration platforms and claims processing systems.
• Bachelor’s degree required; advanced degree (MBA, MHA, or related field) preferred.

Leadership Competencies

• Strategic thinker with operational depth.
• Data-driven decision maker.
• Expertise in change management.
• Strong financial and business acumen.
• Collaborative cross-functional leadership.
• High integrity and accountability mindset.

#LI-JF1