Sr. Manager, Quality Audit

Overview

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: 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 You bring: 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 5 – 7 years Medicare Advantage experience preferred Experience managing/supervising employees Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs. The above statements are intended to describe the general nature and level of the job being performed by the individual(s) assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required. HealthEdge reserves the right to modify, add, or remove duties and to assign other duties as necessary. In addition, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position in compliance with the Americans with Disabilities Act of 1990. Candidates may be required to go through a pre-employment criminal background check. HealthEdge is an equal opportunity employer. We are committed to workforce diversity and actively encourage all qualified persons to seek employment with us, including, but not limited to, racial and ethnic minorities, women, veterans and persons with disabilities. #LI-Remote **The annual US base salary range for this position is $155,000 to $165,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.