***To be considered for this position, all candidates must have extensive background in health care management, medical call center knowledge and claims experience.***

While this role qualifies for remote arrangements, employees are expected to be on-site as required for initial training,attend quarterly in-person meetings and leadership sessions. Location: Brandon, FL

Job Summary
We are seeking a dynamic and experienced Health Plan Operations Manager to lead and optimise the daily operations of our health insurance programs. In this pivotal role, you will oversee the coordination of medical management activities, ensure compliance with healthcare regulations, and drive initiatives that improve member experience and operational efficiency. Your leadership will be instrumental in maintaining high standards of healthcare management while fostering a collaborative environment that promotes continuous improvement and excellence in service delivery.

Duties

• Manage and oversee all aspects of health plan operations, including claims processing, member services, provider relations, and medical management functions
• Develop and implement operational strategies aligned with organizational goals to enhance efficiency, quality, and compliance
• Lead cross-functional teams to ensure adherence to JCAHO (Joint Commission on Accreditation of Healthcare Organizations) standards and other regulatory requirements
• Monitor key performance indicators (KPIs) related to healthcare management, such as member satisfaction, claims accuracy, and provider network performance
• Collaborate with clinical teams to support medical management initiatives that promote cost-effective, high-quality care for members
• Identify opportunities for process improvements and implement best practices across all operational areas
• Ensure comprehensive training programs are in place for staff to stay current with healthcare policies, procedures, and industry standards

Qualifications

• Proven experience in healthcare management or health plan operations, with a strong understanding of medical management processes
• Demonstrated management skills with the ability to lead diverse teams effectively
• Knowledge of healthcare regulations, including JCAHO accreditation standards and compliance requirements
• Strong analytical skills with the ability to interpret complex data and develop actionable insights
• Excellent communication skills to collaborate with internal teams, providers, and external stakeholders
• Bachelor's degree in healthcare administration, business administration or related field; advanced degree preferred
• Experience working within managed care organizations or health insurance companies is highly desirable

Join us in shaping innovative health plan solutions that make a real difference! We are committed to empowering our team members through supportive leadership, professional growth opportunities, and a vibrant work environment dedicated to excellence in healthcare delivery.

ABCT is an Equal Opportunity Employer. We do not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. This position is contingent upon passing a pre-employment background check and drug screen.

Pay: $70,000.00 - $90,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• Bachelor's (Required)

Experience:

• PACE organization : 3 years (Preferred)
• Leadership/Management: 5 years (Required)
• Medicaid/Medicare Advantage: 3 years (Preferred)
• Healthcare management: 5 years (Required)
• Medical Claims : 3 years (Required)

Work Location: Remote