Note: The job is a remote job and is open to candidates in USA. Reflect Health is the evolution of S&S Health, a trusted independent third-party administrator. They are seeking a Director of Operations to lead the execution and performance of healthcare administration operations, ensuring high-quality service delivery and operational improvements across various programs.
Responsibilities
- Own day-to-day operational execution across ASO, Fully Insured, ACA, and Stop-Loss lines of business
- Ensure operational teams deliver accurate, timely, compliant, and high-quality services
- Establish accountability across teams for service levels, productivity, quality, turnaround times, and client commitments
- Manage operational priorities, workload capacity, resource allocation, and business performance
- Ensure operational consistency across lines of business while managing the unique requirements of self-funded ASO administration, Fully Insured plan operations, ACA workflows, and stop-loss administration
- Identify operational risks and opportunities while implementing solutions to improve performance, reliability, and client experience
- Oversee execution of claims administration, eligibility coordination, billing support, stop-loss administration, carrier collaboration, recoveries, and operational controls
- Ensure claims and operational processes meet quality, compliance, financial, and service expectations
- Monitor claims and stop-loss performance, identify challenges, and implement corrective actions
- Partner with internal teams and external stakeholders to resolve operational issues and improve outcomes
- Recruit, develop, coach, and retain high-performing operational teams and leaders
- Establish clear performance expectations, leadership capabilities, and professional development opportunities
- Build a culture of accountability, collaboration, continuous improvement, and customer-focused execution
- Develop organizational capacity to support business growth and evolving operational needs
- Lead managers and teams through operational changes while ensuring engagement and adoption
- Establish and manage operational KPIs, SLAs, quality standards, productivity measures, and service performance goals
- Monitor operational results and implement improvement plans when performance expectations are not met
- Maintain visibility into operational trends, risks, opportunities, and business outcomes
- Provide leadership with insights and recommendations to improve operational effectiveness
- Help identify opportunities to improve operational efficiency, reduce complexity, and enhance service delivery
- Ensure operational teams successfully adopt and sustain new processes, technologies, and operating practices
- Support continuous improvement efforts by identifying root causes, improving workflows, and strengthening operational discipline
- Ensure compliance with applicable federal and state regulations, contractual obligations, internal policies, and healthcare industry requirements
- Support audit readiness, quality assurance programs, and operational governance activities
- Maintain appropriate operational controls and risk management practices
- Ensure teams operate within established compliance and quality standards
- Partner with Technology, Finance, Compliance, Client Success, Implementation, Transformation, and Executive Leadership to resolve operational issues and support business objectives, and work on initiatives involving process improvement, automation, technology enablement, and organizational change
- Communicate operational performance, priorities, risks, and recommendations to executive leadership. Translate business strategy into effective operational execution
Skills
- Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance environment
- Deep knowledge of claims administration, stop-loss operations, healthcare operations, and employer-sponsored health plans
- Demonstrated success leading complex healthcare operations with responsibility for service delivery, team performance, operational metrics, and organizational growth
- Experience managing operational teams, workforce planning, and performance improvement initiatives
- Proven ability to establish accountability, improve service delivery, and scale operational capabilities
- Strong understanding of claims adjudication, eligibility, enrollment, billing operations, EDI transactions, stop-loss administration, and self-funded health plan processes
- Experience supporting ACA, Fully Insured, ASO, and stop-loss operations
- Working knowledge of stop-loss administration, including specific and aggregate recovery processes
- Experience using claims administration platforms, workflow tools, operational reporting, dashboards, and analytics to improve operational outcomes
- Ability to partner effectively with Technology and Transformation teams to implement operational improvements
- Experience using data and performance metrics to identify opportunities and drive accountability
- Strong leadership, communication, and stakeholder management skills
- Ability to develop teams, influence partners, solve complex operational challenges, and communicate effectively with executive leadership
- Ability to translate operational strategy into execution while collaborating across functions
Company Overview