Silver Spring, MD
Full-Time Regular
2019264

Location: Washington, DC area

Hybrid Schedule- onsite 2-3 days a week

Vice President of Operations for the Group Life and Health business unit will provide strategic leadership and oversight to ensure the efficient and effective operation of key functional areas of billing, claims processing, audit functions, and third-party administrator (TPA) relationships.

Principal Duties and Responsibilities:

  • Develop and implement operational strategies to ensure the efficiency and scalability of the company’s operations.
  • Develop and maintain strong relationships with internal departments, third-party vendors, and brokers to ensure seamless operations and a positive customer experience.
  • Billing Oversight: Oversee the end-to-end billing and commission process, ensuring accuracy, timeliness, and compliance with regulatory and company standards. Implement strategies to optimize billing efficiency and resolve discrepancies.
  • Claims Management: Direct the stop loss and life insurance claims department to ensure prompt, fair, and accurate processing of claims. Monitor performance metrics, improve workflows, and ensure exceptional customer service for policyholders.
  • Audit Supervision: Lead internal and external audit processes, ensuring adherence to financial, operational, and regulatory requirements. Develop and maintain robust controls to mitigate risks and ensure compliance while ensuring clear line of sight throughout the organization.
  • TPA Management: Manage relationships with third party administrators, including contract negotiation, performance evaluation, and alignment with company goals. Ensure TPAs deliver high quality services consistent with company standards.
  • Compliance & Reporting: Ensure all operations comply with federal and state insurance regulations, union agreements, and company policies. Ensure compliance with all relevant federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), and other insurance-related laws. Provide regular reports to executive leadership on operational performance and key metrics.

Required:

  • Bachelor’s degree in Business, Insurance, Healthcare Administration or related field
  • Ten years insurance experience, specifically in group life and health insurance with five years in a senior leadership role (AVP or higher).
  • Demonstrated experience in optimizing billing processes, claims adjudication and audit functions to improve accuracy, efficiency and customer satisfaction.
  • MUST HAVE MANAGED a policy load of at least $100 million
  • Demonstrated experience overseeing third-party administrators (TPAs) and vendor relationships.
  • Self starter that leads and listens without micro-managing
  • Must have strong understanding of federal and state regulations, including the Health Insurance Portability and Accountability Act (HIPAA), and other insurance-related laws.
  • Must have strong strategic leadership and decision-making capabilities.
  • Must have the ability to drive a culture of accountability, continuous improvement and operational excellence.