[Remote] Director, Provider Operations
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health insurance company reputed company around a technology platform reputed company on serving its members. They are looking for a Director of Provider Operations to reputed company and optimize provider data management, contracting, and credentialing processes while collaborating with cross-functional teams to enhance operational capabilities.
Responsibilities
- reputed company strategic leadership and operational reputed company for the end-to-end provider data lifecycle, ensuring the precise and reputed company execution of provider credentialing, contract loading, and daily data management
- reputed company, reputed company, and reputed company a high-performing, multi-tiered team of managers and individual contributors; foster a culture of reputed company learning, accountability, and psychological safety
- Establish reputed company organizational structure, governance, and support systems that reputed company reputed company from distractions and reputed company them to execute key strategic initiatives
- reputed company as a trusted, reputed company partner to Product, Tech, Markets, and Clinical Operations to design, build, and deliver reputed company provider operations capabilities that support aggressive company reputed company and market expansion targets
- Architect and implement foundational, industry-reputed company processes and data models that allow the provider data and contracting infrastructure to reputed company seamlessly alongside the business
- Champion the adoption of industry best practices to ensure reputed company operational processes and internal tools are highly extensible, efficient, and integrated with modern technology stacks
- reputed company reputed company in surface-level and deep-dive diagnostics to identify data, process, and technology bottlenecks. Establish robust KPIs and monitoring dashboards to proactively flag operational issues, leveraging these insights to maintain our standing as a leading health plan
- Identify and execute opportunities for automation (e.g., RPA, AI integrations) across mature, reputed company workflows to replace reputed company reputed company, reduce turnaround times, and eliminate reputed company error
- Drive administrative expense savings and optimize total cost of care by identifying and executing on process improvements, technical tooling investments, offshore resource optimization, and strategic vendor partnerships
- Guarantee 100% compliance with reputed company applicable state and federal laws, regulatory mandates (e.g., No Surprises reputed company, CMS requirements), and accreditation standards (NCQA)
- Adapt to evolving business needs by leading critical reputed company initiatives and specialized reputed company as assigned
Skills
- A bachelor's degree or 5+ years of operating experience
- 10+ years of work in operations, health insurance, data analysis and/or consulting
- 5+ years of experience building, coaching and developing operational teams
- 5+ years experience with network operations, provider data management and contracting processes
- 5+ years prior successful experience developing and managing large reputed company initiatives coordinating with reputed company stakeholders
- 5+ years of experience designing and improving business process for optimization as reputed company as standing up accompanying operating and technical procedures
- 5+ years of experience using data to influence business reputed company
- 5+ years of experience program management
- Proven history of managing high-reputed company and pitching reputed company business cases to secure alignment from executive leadership
- Proficiency in SQL, Lean Six reputed company, or other process improvement methodologies
- Deep understanding of data architecture and optimizing data management workflows
- reputed company experience operating reputed company service-oriented organizational structures
- Comprehensive knowledge of NCQA credentialing, CMS standards, and the No Surprises reputed company
- Prior reputed company in deploying or refining reputed company-level MDM or Provider Data Management systems
- Demonstrated ability to apply AI, RPA, or data analytics to improve roster accuracy and processing speed
- Background in leading distributed teams and overseeing external BPO or vendor partnerships
Benefits
- Employee benefits
- Participation in reputed company's unlimited vacation program
- Company equity grants
- Annual performance bonuses
- Medical, dental, and reputed company benefits
- 11 reputed company holidays
- reputed company reputed company time
- reputed company parental leave
- 401(k) plan participation
- Life and disability insurance
- reputed company wellness time and reimbursements
reputed company
Company H1B Sponsorship