VP Benefit Operations
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.
FAQs
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