Sr. Manager, Quality Audit

HealthEdge•Remote,

1d•$155,000 - $165,000•Remote

About The Position

About UST HealthProof At UST HealthProof, you will join a fast paced, growing company in our mission to reshape the future of health insurance through significantly reducing administrative costs and building better healthcare experiences for our health plans customers and their members. By creating a modern, cloud based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created real impact for members. UST HealthProof is run by leaders with strong health plan and technology backgrounds who have start-up mindsets and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, and break down operational barriers to scale and drive strategic growth. UST HealthProof is looking for a Director of Business Operations who under the general supervision of the Vice President of Operations, will be responsible for leading strategies to enhance business performance and outcomes. In this role, you will plan, direct, coordinate, and oversee operational activities to ensure efficient operations and cost-effective systems to meet current and future customer needs. The Candidate should have excellent communication skills and the ability to engage with leaders across the organization. As a Group Manager, Business Operations; you will be responsible for the following:

Requirements

Bachelor’s Degree in Business, Health Services Administration, or related field
A minimum of 8 years of progressive management experience in health plan operations, with a strong understanding of claims processing
Experience managing/supervising employees

Nice To Haves

5 – 7 years Medicare Advantage experience preferred

Responsibilities

Plan, develop, organize, direct and evaluate all aspects of onshore and offshore BPaaS activities
Serve alongside multiple stakeholders, including Configuration, IT Operations, Contact Center Operations, and Medical Management to deliver customer success
Establish operational objectives, policies and procedures ensuring compliance with customer contracts and related laws and regulations
Develop and execute strategies to achieve key performance measures
Identify, recommend, and implement new processes, technologies, and systems to improve and streamline processes and use of resources
Establish and administer the department budget
Provide Executive level briefings to Senior Leadership at regular intervals to keep leadership current with updates and performance levels
Establish strong, collaborative relationships with client leadership
Comply with the organization’s Code of Conduct; all regulatory and contractual requirements; organizational policies; procedures; and internal controls