Remote Health Plan Ops Strategy Lead (BPaaS & Modernization)

HealthEdge; United States; On-site; USD 135,000 - 155,000; Full time

Job summary

HealthEdge is seeking a Senior Health Plan Operations Strategist to lead operations strategy and service design for BPaaS programs. The role involves working closely with health plan executives to shape future-state operating models, guide modernization strategies, and support sales pursuits. Candidates should have over 5 years of experience in health plan operations, strong operational expertise across Core Administration domains, and the ability to translate operational challenges into scalable BPaaS solutions. This role is remote with required travel for client sessions.

Qualifications

• Deep operational expertise in claims, enrollment, billing, and member services.
• Experience in leading executive workshops and translating operational challenges.
• Strong familiarity with Core Admin platforms and BPaaS delivery models.

Responsibilities

• Lead service model design for health plan Core Administration.
• Assess operations and define transition pathways to BPaaS models.
• Support sales teams on strategic BPaaS pursuits and proposals.

Skills

Health plan operations

Core Administration

Operational transformation

BPaaS solutions

Consulting experience

Sales-facing skills

Analytical skills

Education

5+ years in health plan operations

Tools

HealthRules Payer

Facets

QNXT

Javelina

Job description

HealthEdge is seeking a Senior Health Plan Operations Strategist to lead operations strategy and service design for BPaaS programs. The role involves working closely with health plan executives to shape future-state operating models, guide modernization strategies, and support sales pursuits. Candidates should have over 5 years of experience in health plan operations, strong operational expertise across Core Administration domains, and the ability to translate operational challenges into scalable BPaaS solutions. This role is remote with required travel for client sessions.