Strategy and Ops Lead (Insurance Ops)

Alpaca Health•New York, NY

17d•Onsite

About The Position

We are hiring a Strategy and Ops Lead to figure out insurance. You'll turn messy, fragmented insurance feedback into clear processes and scalable systems. Bridge ops and product to use technology to standardize workflows, reduce ambiguity, and drive reliable execution. This role is perfect for people who are fascinated by the details -- who think strange edge cases are interesting, not (just) annoying.

Requirements

You are extremely ambitious and want to build something meaningful at high velocity.
You are comfortable working harder and moving faster than most people.
You thrive in environments with little structure and high accountability.
You are a systems thinker who instinctively turns chaos into repeatable processes.
You can manage a large volume of parallel priorities without dropping details.
You communicate with clarity and judgment, internally and externally.
You bring strong analytical horsepower and can move between strategy and execution seamlessly.
You have experience in consulting, investing, startup operations, healthcare strategy, or similarly demanding roles.
This role is best suited for someone who wants to become a founder or senior operator and is willing to earn that opportunity through real responsibility.
NYC-based candidates (or candidates open to relocation). We work 5 days a week in person.

Responsibilities

Own prior authorization operations
Manage day-to-day prior authorization workflows across providers and payers.
Partner with providers to resolve issues and ensure timely submissions and approvals.
Improve the prior authorization system
Track and synthesize provider feedback to identify failure points in the process.
Translate insights into product and workflow improvements that increase approval rates and speed.
Standardize payer requirements
Build and maintain a system of record for payer-specific documentation requirements.
Continuously refine documentation standards to reduce denials and rework.
Manage reassessments and authorization timelines
Track authorization periods and reassessment deadlines across patients.
Ensure proactive renewals to prevent gaps in care and revenue disruption.
Research complex payer pathways
Investigate and operationalize single case agreements and out-of-network billing strategies.
Develop playbooks for edge cases and non-standard payer scenarios.
Own eligibility operations and escalations
Manage eligibility check workflows and resolve escalations quickly.
Improve accuracy and turnaround time of benefits verification.
Build patient responsibility workflows
Develop tools and processes to clearly determine patient financial responsibility.
Design and implement systems for collecting copays, coinsurance, and balances.
Streamline payer communications
Own fax and payer mailbox operations, including intake, triage, and response workflows.
Identify and implement automation opportunities to increase speed and reliability.
Drive continuous operational improvement
Identify bottlenecks across insurance operations and design scalable solutions.
Work closely with Product and Engineering to embed these improvements into the platform.