Health Plan Operations Specialist

VIPcare•Tampa, FL

1d•$47,000 - $58,000

About The Position

The Health Plan Liaison serves as the primary operational link between Better Health Group, affiliated primary care physician (PCP) offices, and assigned health plan partners. Reporting to the Manager, Operations, this position manages intake, research, and resolution of health plan-related inquiries for assigned PCP offices, working with health plan representatives and internal teams to address issues affecting provider operations, member access, and health plan partnerships. The role also strengthens partnerships by coordinating Health Plan Joint Operations Committee (JOC) meetings, supporting health plan onboarding and the Annual Enrollment Period (AEP), and developing and maintaining health plan resources and quick reference guides. Through relationship management, sound judgment, and proactive communication, the Health Plan Liaison helps ensure policies and procedures are understood and consistently applied, recurring issues are identified and escalated, and Better Health Group maintains productive relationships with health plan partners.

Requirements

High school diploma or equivalent required.
At least 3 years of experience in a healthcare-related environment.
Proficiency in Google Workspace (Drive, Docs, Sheets, Slides) and Microsoft Office (Word, Excel, PowerPoint), including experience maintaining trackers, presentations, and reference documents.
Ability to research and resolve issues of varying complexity, exercise sound judgment, and determine when escalation is appropriate.
Ability to work cross-functionally with multiple teams and independently with minimal supervision.
Strong organizational, time-management, and multitasking skills, with attention to detail.
Excellent written and verbal communication skills, including comfort communicating with internal and external stakeholders, providers, and health plans.
Strong interpersonal, meeting facilitation, and presentation skills.
Strong critical-thinking and problem-solving skills.
Ability to adapt to shifting priorities in a fast-paced environment.
Results-oriented, with a focus on quality execution and delivery.
Ability to maintain confidentiality when handling sensitive provider, member, and business information.
Appreciation of cultural diversity and sensitivity toward team members, providers, and the patient populations served.
Ability to remain primarily seated for extended periods while performing computer-based and administrative work.
Ability to regularly operate a computer, keyboard, mouse, telephone, and other standard office equipment.
Ability to communicate and exchange information in person, by telephone, and through virtual communication platforms.
Ability to review electronic records, spreadsheets, and detailed documentation for accuracy and completeness.
Ability to occasionally stand, walk, bend, and reach during routine office activities.
Ability to occasionally lift or carry office materials weighing up to 15 pounds.
Positive work ethic and ability to model the organization's core values and guiding principles.
Effective team player who contributes ideas and feedback and can be counted on to meet commitments.
Ability to approach tasks and challenges with energy and passion, pursue goals with focus, and complete commitments.

Nice To Haves

Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or a related field.
Experience with health plans, managed care, Medicare Advantage, or provider relations.
Working knowledge of health plan operations, policies, and procedures.

Responsibilities

Serve as the primary contact for assigned PCP offices regarding health plan inquiries, issues, and requests.
Manage intake of health plan inquiries through the internal ticketing process and track them from receipt through resolution.
Research and investigate inquiries, coordinate with health plan representatives and internal teams, and escalate issues to leadership as needed.
Identify recurring issues, trends, and process gaps across PCP offices and health plans, and recommend improvements to leadership.
Maintain knowledge of health plan policies, procedures, requirements, and resources, and communicate relevant changes to PCP offices and internal teams.
Build collaborative relationships with PCP offices, health plan partners, and internal teams.
Schedule and lead Joint Operations Committee meetings.
Prepare and distribute meeting agendas and presentations in advance; document and distribute action items afterward and track them through completion.
Maintain accurate agendas and action-item records for recurring operational meetings.
Maintain responsive working relationships with internal and external stakeholders to support communication and service delivery.
Facilitate health plan onboarding by coordinating required information, communications, and follow-up among health plans, PCP offices, and internal teams.
Support tasks associated with the annual Annual Enrollment Period (AEP) process.
Create, update, and maintain health plan resource documents and quick reference guides for internal and external users.
Identify needs for new or updated resources based on requests and recurring questions.
Attend and participate in Core Operations team meetings, health plan meetings, and interdepartmental market meetings as required.
Perform additional duties as assigned.