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 Apply tot his job Apply To this Job
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