Operations Strategy Consultant

Job Description:

• Lead service model design and solution blueprinting for health plan Core Administration transformation initiatives
• Assess current-state operations on legacy platforms and define transition pathways to BPaaS delivery models on the HealthEdge ecosystem
• Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations
• Identify opportunities to embed automation, AI-enabled workflows, and intelligent process orchestration into operational service models
• Recommend operating model patterns that reduce administrative burden, improve turnaround times, and drive measurable cost and quality outcomes
• Support Advisory and Sales teams on strategic BPaaS pursuits, proposals, and RFP responses
• Conduct current-state assessments of Core Admin operations, staffing models, and process maturity
• Create modernization roadmaps and platform transition strategies grounded in operational realities and health plan business priorities
• Mentor team members on Core Admin operational domains, BPaaS service design principles, and health plan business context

Requirements:

• 5+ years in health plan operations, Core Administration, or healthcare BPaaS strategy
• Deep operational expertise across one or more Core Admin domains: claims, enrollment, billing, benefits administration, UM, A&G, provider, and member services
• Prior consulting, managed services, or advisory experience with a health plan, SI, or BPaaS vendor
• Proven ability to assess operational models and design future-state BPaaS service blueprints
• Strong familiarity with Core Admin platforms (HealthRules Payer, Facets, QNXT, QicLink, Javelina, or equivalent)
• Strong sales-facing skills: whiteboarding, pursuit support, and executive communication with health plan leadership
• Exceptional analytical, communication, and client-facing presence

Benefits:

• Health insurance
• Retirement plans
• Paid time off
• Flexible work arrangements
• Professional development
• Bonuses
• Stock options

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