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Harbor Health looking for a GM - Insurance Operations and Technology to become a member of our team! Harbor Health is an entirely new multi-specialty clinic group in Austin, TX utilizing a modern approach to co-create health with those who get, give, and pay for it, allowing everyone to fully flourish. Join us as we build a fully integrated system that connects care to a better payment model that truly puts the human being at the center.

The GM - Insurance Operations and Technology will be accountable for delivering enjoyable experiences from launch date through scale to our health plan constituents (consumers, providers, employers). Responsible for building, configuring, scaling and optimizing processes related to benefit configuration, claims adjudication, provider payments, and regulatory compliance.
As the leader building and servicing our insurance operations, you will be responsible for managing and executing cross-functional processes related to business and operational readiness, and operational excellence.
This role provides the opportunity to take our health plan operation from concept to creation and then scale it post-launch.

Our GM - Insurance Operations and Technology will be responsible for:

• Stand up the function that supports and builds scalable processes for benefit configuration, claims adjudication, provider payments and all supporting functions (such as enrollment, UR, UM, quality, compliance and reporting).
• Plan, manage, and oversee all operation support of vendor relationships, working with the internal team and vendor to ensure performance is meeting Harbor’s expectations.
• Work cross-functionally with internal teams (e.g., Underwriting, Compliance, and Product) to develop, define, and document business needs and requirements, and ensure they are executed.
• Identify the root cause of operational defects and implement solutions for in-house and delegated processes
• Support new customer acquisition through enrollment and attribution
• Provide business requirements and cross functional support in the building, configuring, and improving Harbor’s ability to adjudicate claims accurately and efficiently
• Implement regulatory and business requirements into workflows and processes
• Implement and monitor key controls
• Effectively lead the scoping of health plan operational projects, setting clear and defined objectives and goals and measures performance against goals/results
• Establish strategic service partnerships as needed to maximize the mix of in-house versus outsourced services to optimize cost of services to the health plan and its customers.
• Manage vendor contracts including payment, and adherence to contractual SLAs, including managing functions performed by in-house teams as well as functions delegated to vendors.
• Other duties as assigned.

Successful GM - Insurance Operations and Technology will have:

• 15 years of relevant healthcare experience, particularly with regard health plan operations and technology (experience with physician groups taking risk a plus)
• Strong experience in developing and executing major strategic projects and initiatives in support of health plan and multi-specialty clinic operations.
• Demonstrated success operating high-growth companies
• Data analysis skills including the ability to pull data from source systems
• Demonstrated creativity in identifying and implementing solutions to complex, ambiguous issues
• Ability to lead project teams and act as team player
• Have the ability to partner in the development, management and operationalizing processes and workflows to maximize efficiencies.
• Undergraduate degree in technology, healthcare administration, or related field.

Additional Skills & Experiences Preferred include:

• Commercial, Medicare and Medicaid insurance experience with state and federal product filing
• Experience implementing and operating delegated TPA, UM, UR, credentialing and related functions
• Experience creating and implementing operational analytics infrastructure
• Experience negotiating vendor contracts in the functions described above
• Experience developing and administering value-based payment arrangements
• Masters in Healthcare or Business Administration or other related fields

Physical Requirements of the role include:

• This is a US-based remote role
• Up to 25% travel expectation

If you are passionate about health care and you want to create something new together, we want you to be apart of our team!