AVP, Operations

Western Growers Health; Irvine, Northern (CA, KY); Hybrid; USD 155,000 - 213,000; Full time

Job summary

Western Growers Health seeks an Associate Vice President, Operations to drive strategic direction and operational excellence for Administration, installation, billing, and benefit distribution. You will lead the Director, Administration and collaborate with Finance, Compliance, and Sales to scale capabilities and ensure high client satisfaction.

The role requires extensive leadership experience in health benefit administration, strong budgeting skills, and a track record of delivering process

Qualifications

• BS/BA degree in healthcare administration, business, finance, or a related field; advanced degree a plus; ten (10) to twelve (12) years of experience in group health benefit administration, including installation, premium billing/invoicing, and benefit distribution.
• Five (5) years minimum in a senior leadership role directing managers and/or supervisors.
• Proven ability to lead and manage complex, business-critical implementation and billing/finance projects in a client-facing role at an enterprise level; strong grounding in change management principles and methodologies.
• Extensive knowledge of group health care administration and applicable legal requirements (HIPAA, ERISA, ACA/PPACA) as they relate to installation, billing, and benefit distribution operations.

Responsibilities

• Own the enterprise strategy and operating model for Installation, Benefit Distribution, and Finance Administration functions across WGAT and PCMI.
• Set departmental goals, KPIs, and service standards for installation quality, billing accuracy and timeliness, and client satisfaction.
• Oversee and manage the department's budget and staffing plans across installation, billing, and benefit distribution.
• Serve as executive escalation point for the most complex issues and report performance to leadership.
• Ensure compliance with ERISA, CDI, and DOL regulations and coordinate with internal stakeholders.

Skills

Strategic leadership

Budgeting

Change management

Executive communication

Education

BS/BA in healthcare admin, business, finance

Advanced degree (plus)

15+ years experience in lieu of education

Tools

Project management tools

Microsoft Office Suite

Health plan admin & billing systems

Job description

# AVP, OperationsFully Remote • Irvine Office - Irvine, CA 92618## OverviewSalary Range$155,218.95 - $213,426.32 SalaryPosition TypeFull TimeTravel PercentageUp to 25%CategoryOther## Description# Job Description SummaryThe Associate Vice President (AVP), Operations sets the strategic direction and operational oversight for the Administration function supporting new business implementation, client renewals, premium billing, non-premium invoicing and remittance, financial reporting, and benefit distribution for group health benefit plans for Western Growers Health and Pinnacle Health Solutions. This role owns the department's operating model — including staffing, budget, and process standards — ensuring new and renewal customer implementations, billing, and invoicing activities are executed with a high degree of quality, accuracy, and client satisfaction. The AVP leads the Director, Administration, translating enterprise priorities into departmental execution, and represents installation, billing, and benefit distribution performance to executive leadership. The AVP also drive Provider contracting strategy and execution. This position reports to the Vice President, Key Accounts and partners cross-functionally with Finance, Claims, Compliance, Provider Operations, and Sales/Account Management to ensure these capabilities scale with, and advance, the company's business objectives.# Duties And ResponsibilitiesStrategic Leadership & Program Ownership* Own the enterprise strategy and operating model for Installation, Benefit Distribution, and Finance Administration (premium billing, non-premium invoicing and remittance) functions across WGAT and PCMI.* Set departmental goals, KPIs, and service standards for installation quality, billing accuracy and timeliness, and client satisfaction, and report performance to executive leadership.* Own the department budget and staffing plan across installation, billing, and benefit distribution activities.* Serve as the executive-level escalation point for the most complex installation, billing, and benefit distribution issues.* Represent installation, billing, and financial reporting performance in senior leadership and WGAT Trustee-level reporting forums.* Evaluate emerging regulatory requirements (e.g., ERISA, CDI, DOL) and industry trends, and set the direction for how the organization adopts them.Governance & Oversight* Direct the oversight of installation processes and premium billing/non-premium invoicing and remittance processes for new and renewal customer implementations, delegating execution to the Director, Administration and their team (Manager, Finance Administration; Supervisor, Benefit Distribution and Installation).* Ensure administrative, billing, and invoicing processes and procedures maximize employee production and compliance with ERISA, CDI, and DOL regulations.* Direct the development of KPI reporting for weekly VP, monthly Senior Leadership, and quarterly WGAT Trustee reporting on installation, billing, and benefit distribution performance.* Collaborate with internal stakeholders, review contracts, and provide business reporting related to implementation and billing.* Hold the Director, Administration accountable for timely resolution of installation, billing, and benefit distribution issues, and personally engage on the highest-impact escalations.Process Improvement* Partner with other department leaders and key stakeholders on driving new process implementation with a focus on intercompany transparency, communication, and data sharing.* Plan, deploy, and lead lean activities that produce significant cost savings through productivity, quality, and waste-reduction improvements in installation, billing, and benefit distribution.* Oversee and guide the development of comprehensive process improvement plans to be shared with stakeholders.* Develop and promote data-driven solutions for installation, billing, and benefit distribution.* Train frontline supervisors on continuous improvement and leadership skills.Management & Leadership* Build, develop, and lead the Director, Administration across Installation, Benefit Distribution, and Finance Administration as well as Manager, Provider Operations, ensuring clear roles and service expectations at every level (including the Manager, Finance Administration and the Supervisor, Benefit Distribution and Installation).* Develop a culture of real, personal accountability by modeling the behavior that defines it, cascading that standard through the leadership team.* Instill a culture of safety and expectation across the installation and benefit distribution function.* Hold the Director, Administration accountable to high standards of performance and personal conduct, in a clear, helpful, straightforward way.* Conduct one-on-one conversations with the Director, Administration on a quarterly basis, focused on capabilities, impact, and effort.* Own staffing decisions — selection and hiring, role clarity, performance management, and correction/discipline/termination — using the “Outward Mindset Skills for Leaders” guide.* Ensure a robust mentorship, leadership, management, and technical training program is in place to continually develop staff.* Create a succession and career development plan for staff within area of responsibility.Other* Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning and executing work in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.* Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.* Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.* Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).* Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 25% of the time.* All other duties as assigned.# Physical Demands/Work EnvironmentThe physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand, walk and sit. The employee is frequently required to use hands to finger, handle, or feel objects, tools, or controls and reach with hands and arms. The noise level in the work environment is usually moderate.## Qualifications# Qualifications* BS/BA degree in healthcare administration, business, finance, or a related field; advanced degree a plus; ten (10) to twelve (12) years of experience in group health benefit administration, including installation, premium billing/invoicing, and benefit distribution. Fifteen (15) or more years of relevant work experience in lieu of education requirements.* Five (5) years minimum in a senior leadership role directing managers and/or supervisors.* Proven ability to lead and manage complex, business-critical implementation and billing/finance projects in a client-facing role at an enterprise level; strong grounding in change management principles and methodologies.* Demonstrated experience developing departmental budgets and evaluating profit and loss statements across installation, billing, and benefit distribution functions to ensure compliance with budget at a multi-team level.* Successful experience in managing group health benefits implementations for onboarding and renewing customers.* Proven ability to mentor and develop supervisory and managerial staff, building leadership bench strength.* Ability to anticipate bottlenecks, provide escalation management, and make necessary tradeoffs across installation, billing, and benefit distribution activity.* Extensive knowledge of group health care administration and applicable legal requirements (HIPAA, ERISA, ACA/PPACA) as they relate to installation, billing, and benefit distribution operations.* Demonstrated analytical and process improvement skills with a data-driven approach; strong quantitative skills to spot patterns, trends, and opportunities across installation and billing data.* High level of competency in computer skills, including project management tools, health plan administration and billing systems, and Microsoft Office Suite.* Strong written and verbal communication skills, including the ability to represent installation, billing, and benefit distribution performance to executive leadership.* Proven ability to multi-task and manage many concurrent implementation and billing/finance projects and demands.* Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 25% of the time.