Director, TPA Operations

Gallagher•San Diego, CA

15h

About The Position

Join VEBA Direct, a groundbreaking DMHC-approved pilot program in California, as the Director of TPA Operations. This role is your opportunity to lead, scale, and professionalize the operational oversight of our Third Party Administrator (TPA) relationship. You’ll ensure our innovative employer-direct model operates efficiently, compliantly, and better than traditional health plans. In this role, you’ll take full ownership of TPA operations, driving vendor performance, compliance, and operational excellence. You’ll lead new client implementations, manage complex projects, and ensure seamless transitions into steady-state operations. By optimizing processes and enabling scalability, you’ll position VEBA Direct for growth and success. You’ll also act as a trusted partner to internal teams, provider medical groups, and external stakeholders, ensuring alignment and collaboration.

Requirements

10+ years of experience in health plan operations, with expertise in delegated models and TPA oversight.
Hands-on knowledge of claims, eligibility, provider management, and other core operational functions.
Proven ability to lead complex implementations in regulated environments.
Strong skills in contract interpretation, vendor accountability, and stakeholder management.
A bachelor’s degree (required)
A proactive, organized, and collaborative approach to problem-solving and execution.

Nice To Haves

A master’s degree (MBA, MPH, or related field) is preferred.

Responsibilities

Own the day‑to‑day operational relationship with the Third‑Party Administrator, ensuring performance meets contractual obligations, service levels, and regulatory requirements.
Provide oversight of all subcontracted and delegated functions performed by the TPA, including performance monitoring, issue escalation, root cause analysis, and continuous improvement.
Ensure ongoing compliance with DMHC requirements and delegated model standards.
Maintain audit readiness and lead operational support for regulatory reviews, audits, and inquiries.
Hold vendors accountable through data‑driven performance management and documented remediation plans.
Lead all new client implementations, expansions, and operational changes across the VEBA Direct book of business.
Serve as the operational owner for implementation planning and execution, including: Master project plans and timelines Data migration and system integrations Testing, validation, and readiness assessments Regulatory and contractual compliance checkpoints Risk identification, mitigation, and issue management
Partner with internal teams, the TPA, and external stakeholders to establish realistic milestones and Go‑Live dates, ensuring delivery against commitments.
Ensure seamless transition of accounts from implementation into steady‑state operations.
Monitor and analyze operational performance metrics to identify opportunities for increased efficiency, accuracy, and scalability.
Lead process optimization and technology enablement initiatives to support growth, new products, and evolving regulatory requirements.
Identify system enhancements and workflow improvements across delegated operational functions.
Act as a highly visible internal and external operational leader and trusted partner to the TPA, provider medical groups, and internal teams.
Serve as the primary operational contact for PMG onboarding in partnership with the Network Manager.
Lead internal and external project meetings; develop agendas, document decisions, and track action items to completion.
Advise internal stakeholders and vendor partners on operational best practices, system capabilities, staffing models, and workflow design.
Develop and maintain comprehensive operational and project documentation, including: Project plans and status reporting Risk and issue logs Communication and change management plans Integration and technology documentation Go‑Live materials and acceptance deliverables
Create executive‑ready reports, presentations, process flows, program manuals, and training materials.
Plan and facilitate training sessions for internal teams, clients, and vendor partners (virtual and onsite as needed).
Support the development, implementation, and enforcement of operational policies and procedures in alignment with leadership direction.

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program