Position Overview

The Vice President of Operations is a senior leadership role responsible for overseeing end-to-end operational delivery for a Third-Party Administrator (TPA) specializing in government-sponsored and public sector benefits programs. This individual will drive operational excellence, regulatory compliance, scalability, and client satisfaction across complex, multi-jurisdictional contracts (e.g., state, municipal, and federal programs).

The VP will serve as a strategic partner to executive leadership and a key liaison to government clients, ensuring high-performance service delivery aligned with contractual obligations, compliance standards, and evolving regulatory requirements.

Key Responsibilities

Operational Leadership

• Lead all core TPA operations including eligibility, enrollment, billing, claims administration, customer service, and vendor management.
• Drive continuous improvement initiatives to enhance efficiency, accuracy, and service quality across operations.
• Develop and implement scalable operating models to support growth in government contracts and membership expansion.

Government Contract Execution

• Oversee operational execution of public sector contracts, ensuring strict adherence to SLAs, performance guarantees, and contractual requirements.
• Partner with legal, compliance, and client teams to interpret and operationalize RFP requirements, amendments, and regulatory mandates.
• Act as a senior escalation point for government clients and stakeholders.

Compliance & Regulatory Oversight

• Ensure full compliance with federal, state, and local regulations, including but not limited to:
  • ERISA, HIPAA, ACA
  • CMS guidelines (as applicable)
  • State-specific public program requirements
• Maintain audit readiness and lead responses to external audits, program reviews, and performance evaluations.

Client & Stakeholder Management

• Build trusted relationships with government agencies, plan sponsors, consultants, and key partners.
• Participate in client governance meetings, reporting on operational performance, KPIs, and improvement initiatives.
• Support business development efforts, including RFP responses, oral presentations, and transition planning.

Team Leadership & Development

• Lead and mentor a high-performing operations organization, including directors and department heads.
• Establish a culture of accountability, collaboration, and customer-centric service.
• Align organizational structure and talent strategy with growth objectives and contract demands.

Technology & Process Optimization

• Partner with IT and product teams to enhance TPA platforms, automation, and reporting capabilities.
• Champion data-driven decision-making using performance metrics and analytics.
• Lead system implementations, conversions, and integrations tied to new government contracts.

Qualifications

Required Experience

• 12+ years of experience in benefits administration, TPA operations, or managed care.
• 5+ years in senior leadership (VP or equivalent) overseeing large-scale operations.
• Demonstrated success managing government contracts (state, federal, or municipal), including Medicaid, public employee benefits, or similar programs.
• Deep understanding of health & welfare benefits administration.

Technical & Functional Expertise

• Strong knowledge of:
  • Claims and eligibility systems
  • TPA operating models
  • Regulatory frameworks (ERISA, HIPAA, ACA, CMS where applicable)
• Experience managing complex SLAs, KPIs, and performance guarantees tied to government contracts.

Leadership & Soft Skills

• Executive presence with strong client-facing capabilities.
• Proven ability to lead large, distributed teams.
• Strategic thinker with a hands-on, execution-oriented approach.
• Exceptional problem-solving and process improvement mindset.

Preferred Qualifications

• Experience with public sector consulting or working with labor unions, multi-employer plans, or government-sponsored programs.
• Background supporting RFPs and implementations for new government contracts.
• Lean Six Sigma or operational excellence certification.
• Master's degree (MBA, MHA, or related field).

Compensation

• Base Salary: $200,000-$275,000 (flexible based on experience)
• Bonus: Performance-based annual incentive (20-40%)
• Long-term incentives/equity (if applicable)
• Comprehensive benefits package

Why This Role

• Opportunity to lead operations for mission-critical public sector programs.
• High visibility with executive leadership and government stakeholders.
• Ability to drive meaningful impact in healthcare and benefits access at scale.