Note: The job is a remote job and is open to candidates in USA. HealthEdge is a healthcare technology company. The VP, Advisory Operations leads advisory engagements for health plans, assessing core administration technology and operations and developing business cases for HealthEdge's BPaaS operating model. The role also guides transformation roadmaps, financial models, stakeholder relationships, and executable operating models involving automation and AI-driven processes.
Responsibilities
- Actively engage and work with various team members in assessing health plan Core Administration and operations, identifying root-cause drivers of cost, quality, and compliance gaps
- Review assessment findings into a future-state roadmap and business/technology blueprint that positions BPaaS as the path to improved efficiency, compliance, and operational outcomes
- Quantify the opportunity - cost takeout, service-level improvement, error reduction - and build the financial model (ROI, IRR, cost-benefit) that makes the business case credible to finance and operations leadership
- Define clear accountability across the advisory engagement lifecycle
- Identify where automation and AI-driven processes can streamline administrative tasks, reduce manual error, and strengthen the case for transformation
- Partner with Sales, solution and delivery teams to ensure the roadmap and business case translate cleanly into an executable operating model
- Build and sustain relationships with client stakeholders from analyst to C-suite, adapting the narrative and level of detail to the audience
- Bring outside-in perspective - competitive intelligence, regulatory shifts (CMS, state Medicaid), platform capabilities - to keep assessments grounded in what "good" looks like in the market today
Skills
- 10+ years in health plan operations leadership or consulting focused on health plan operations (claims, enrollment, billing, member/provider service)
- Track record of managing teams, leading operational assessments and translating findings into board or C-suite ready recommendations
- Experience evaluating in-flight or prior transformation initiatives - knowing how to diagnose why a program is stalled, underperforming, or ready to scale
- Working knowledge of core administrative platforms (e.g., HealthRules Payer, Facets, QNXT, QicLink) and how operating model choices affect cost-to-serve
- Financial modeling experience: outcome-based pricing, cost-benefit analysis, ROI/IRR, and the discipline to defend the numbers under scrutiny
- Experience structuring and positioning transformation or BPaaS-style solutions for complex, multi stakeholder deals
- Demonstrated ability to build and grow relationships with operations leadership, from director level through C-suite
- Comfort managing ambiguity - assessments rarely start with clean data, and part of the job is knowing which questions to ask to get there
- Team leadership: delegates well, holds people accountable to outcomes, and knows when to bring in a subject-matter specialist versus handling it personally
- Remote, US
- Full-time, permanent
- The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus
- Work across multiple time zones in a hybrid or remote work environment
- Long periods of time sitting and/or standing in front of a computer using video technology
- May require travel dependent on company needs
Benefits
- Remote work environment
Company Overview
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