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Operations Strategy, BPaaS Solution Lead
HealthEdgeLead operations strategy and service design for BPaaS initiatives at HealthEdge. Collaborate with health plan executives and operations leaders to shape modern operating models.
About the role
Key responsibilities & impact- 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.
- Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations—focusing on delivery efficiency and outcomes.
- Define how BPaaS service layers connect across the health plan ecosystem, identifying opportunities to embed automation and AI-enabled workflows into operational service models.
- Support Advisory and Sales teams on strategic BPaaS pursuits and proposals, leading operational discussions with health plan leadership.
- Conduct current-state assessments of operations and create modernization roadmaps.
- Mentor team members on Core Admin operational domains and represent Advisory in client workshops and sessions.
Requirements
What you’ll need- 10–15+ 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.
- 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.
- Preferred Experience leading or advising on migrations from legacy platforms to modern SaaS or BPaaS delivery models.
- Familiarity with AI/ML, intelligent automation, and digital operations transformation within health plan settings.
- Prior consulting, managed services, or advisory experience with a health plan, SI, or BPaaS vendor.
Benefits
Comp & perks- HealthEdge commits to building an environment and culture that supports the diverse representation of our teams.
- We aspire to have an inclusive workplace. We aspire to be a place where all employees have the opportunity to belong, make an impact and deliver excellent software and services to our customers.
ATS Keywords
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Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Core Administrationhealthcare BPaaS strategyoperational model assessmentBPaaS service blueprint designclaims managementenrollment processesbilling systemsbenefits administrationprovider relationsmember services
Soft Skills
analytical skillscommunication skillsclient-facing presencementoringexecutive communicationsales supportleadershipstrategic thinkingcollaborationproblem-solving