Chief Operating & Experience Officer, Health Plan, Sioux Falls, SD

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The Chief Operating & Experience Officer, Health Plan is a critical executive-level role within the Sanford Health Plan (SHP) with operational responsibility and financial accountability for $1B in premium revenue. This role has executive responsibility for core health plan operations including call center, claims, billing and enrollment and government programs. Overall responsibility for health plan core operations. This includes claims, billing and enrollment, customer service, and provider relations. Has operational oversight for regulatory and risk functions, including government programs operations and risk adjustment functions. Further, oversees member and employee experience strategies, setting the vision and goals for the culture and experience at the health plan and creating a differentiated experience for members that establishes consumer loyalty and enables growth. Serves as a member of SHP executive leadership team, interacting with Health Plan CEO and the Health Plan Board.

Responsible for operational excellence with accountability across all health plan operations. This includes oversight for: Overall operational process improvement including continuous process improvement, quality assurance, operations training, product implementation, performance measurement, project prioritization and operational capacity planning. Organizational efforts to ensure company processes are compliant and aligned with regulatory requirements across multiple states. Drives quality activities and initiatives, ensuring operational systems and processes are delivering in accordance with products sold, contractual commitments, performance guarantees, and business policies. Responsible for growing provider relations, including maintaining current provider relationships with key provider groups and continuous development of network strategy. Oversees the operational and financial performance of agreements and network adequacy/performance results, optimizing the contracting process to achieve intended outcomes. Ensure cost effective, client-responsive programs are developed and maintained, identify improvement opportunities and oversee successful implementation of those changes throughout shared services. Identify operational efficiencies, meet regulatory requirements and client expectations and develop a 'best practice' for operations. Responsible for achieving business unit financial targets and requirements based on service level, state, compliance and contractual agreements. Assess organizational strengths and weaknesses to drive a high-performing operating model. Lead the transformation of health plan operations (people, process, technology) to create a high-performing and competitive health plan.

Qualifications

Master’s degree required or past ten years experience commensurate with area of responsibility.

A demonstrated record of significant career progression, culminating in a senior management position required. A minimum of 5 years of health care or health plan management experience and experience in an executive role preferred.

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