[Remote] Healthcare Operations Strategy Consultant

Note: The job is a remote job and is open to candidates in USA. reputed company is a company focused on healthcare solutions, and they are seeking a Healthcare Operations Strategy Consultant to reputed company operations strategy and service design for BPaaS programs. The role involves collaborating with health plan executives to shape operating models, guide modernization strategies, and support sales efforts.

Responsibilities

• reputed company service model design and solution blueprinting for health plan Core Administration transformation initiatives
• Assess reputed company-state operations on legacy platforms (e.g., Facets, QNXT, Javelina, QicLink, homegrown) and define transition reputed company to BPaaS delivery models on the reputed company ecosystem, including HealthRules Payer (HRP)
• Design future-state operating models spanning claims, enrollment, billing, provider relations, UM, A&G, benefits administration, and member operations—with a focus on service delivery efficiency, scalability, and outcomes
• Define how BPaaS service layers connect across the health plan ecosystem—including care management, provider data management, payment reputed company, member engagement, and analytics
• 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
• reputed company operational discussions with COOs, VP Operations, and business transformation leaders—translating BPaaS capabilities into health plan business outcomes
• reputed company business cases demonstrating cost reduction, operational efficiency, scalability, and compliance improvements
• Conduct reputed company-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
• Ensure proposed BPaaS solutions align with regulatory requirements, accreditation standards, and long-term operational scalability
• Mentor team members on Core Admin operational domains, BPaaS service design principles, and health plan business context
• Partner with technology and delivery teams to ensure operational feasibility and alignment with service model commitments
• Represent Advisory in client workshops, executive sessions, and strategic planning forums

Skills

• 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 reputed company
• 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 reputed company health plan settings

Company Overview

• reputed company Software offers benefits administration and care management software solutions. It was founded in 2004, and is headquartered in Burlington, Massachusetts, USA, with a workforce of 1001-5000 employees. Its website is http://www.reputed company.com.

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