Healthcare Operations Strategy Consultant

HealthEdge

Healthcare Operations Strategy Consultant responsible for leading BPaaS initiatives for health plans. Collaborating with executives to transform operational models and improve service delivery.

Posted 5/21/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $135,000 - $155,000 per yearWebsite

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, and more.
Define how BPaaS service layers connect across the health plan ecosystem.
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.
Mentor team members on Core Admin operational domains and BPaaS service design principles.

Requirements

What you’ll need

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).

Benefits

Comp & perks

Health insurance
401(k) matching
Paid time off
Remote work options
Professional development opportunities

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Core AdministrationBPaaS strategyoperational model assessmentservice design principlesfuture-state blueprint designclaims processingenrollment managementbilling operationsbenefits administrationprovider services

Soft Skills

leadershipmentoringstrategic thinkingcommunicationcollaborationproblem-solvingadvisory skillsconsultingteam supportprocess maturity assessment