Campus Pride Jobs

Base Salary Range: $148,629.77 - $357,640.37 Looking for a way to make an impact and help people? Join PacificSource and help our members access quality, affordable care! PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age. Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths. The SVP, Health Plan Operations is a key member of the Senior Leadership Team, reporting to the Chief Executive Officer. The SVP, Health Plan Operations plays a key role in developing and implementing the Company's strategic and business plans with a focus on designing operational processes, member and provider touchpoints, and operating systems to support health risk identification and management, operational excellence, compliance, and a culture supportive of employee development and satisfaction. The SVP, Health Plan Operations partners closely with other senior leaders to ensure Company's Operations meet customer needs and expectations and meet or exceed market competitive standards. The SVP, Health Plan Operations is responsible for key functions, including claims processing, payment integrity, customer service, product configuration and implementation, membership, enrollment and billing, business continuity, quality assurance, grievance, operations training, performance measurement, project prioritization and operational capacity planning, among other duties. The role ensures company processes are compliant with regulatory and legal requirements across multiple states and lines of business, and ensures systems and processes are operating in accordance with products sold, contractual commitments, performance guarantees, and business policies. The SVP, Health Plan Operations also ensures company processes deliver on management goals including quality, timeliness, and efficiency, regularly developing and implementing quality/process improvement initiatives to continuously improve performance. The SVP, Health Plan Operations is responsible for developing an d achieving business unit production and financial targets and requirements based on Line of Business market requirements, federal and state regulatory requirements, contractual agreements, and enterprise budgets. The SVP, Health Plan Operations maintains a deep knowledge of industry best practices and makes recommendations to ensure Company systems and processes remain market competitive. The SVP, Health Plan Operations works with Line of Business owners to develop and implement business processes and systems that meet the unique customer and market needs of each Line of Business. As a key leader, the SVP, Health Plan Operations has responsibility to continuously assess organizational strengths and weaknesses to drive a high-performing operating model, recruit top talent, develop organizational bench depth, cultivate a culture of trust and transparency, and reinforce the Company's mission and values in daily work. Essential Responsibilities: * Oversee Operations to achieve budgeted profit results and other financial criteria and to preserve the organization's assets. * Oversee the development and implementation of procedures and controls to promote efficient and effective Operat To view the full job description,