Operations Strategy Consultant

Work from home Full-time role Hiring

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:

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