VP, Member Operations

We exist for workers and their employers -- who are the backbone of our economy.  That is where Centivo comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

Summary of Role:

The VP, Member Operations position combines operational experience with process orientation and strong leadership capabilities to simultaneously champion both operational excellence and organizational success over Member/Provider Care/Call Center, Care Management, Client/Member Issue Resolution, and Open Enrollment and New Member Acquisition. This role has responsibility for delivery and execution, tracking, course-correcting, and reporting on relevant operational metrics while managing operational spend in their area.

Duties & Responsibilities:

• Provide coaching and mentorship to department leads and develop talent within the department

• Partner with Finance and executive leadership to manage budgets, assess ROI, and align operational investments with business goals

• Collaborate with internal stakeholders including Product, Technology, Network, Implementation and Clinical to ensure seamless operations and member experience

• Participate in enterprise-level strategy sessions to inform Centivo’s go-forward service model and scalability roadmap

• Provide departmental leadership and operational oversight in assigned third-party medical benefits administration departments

• Develop and implement operational strategies, policies, and procedures to ensure efficient, high-quality service delivery and regulatory compliance

• Lead operational improvement initiatives, including performance management, process automation, and cost reduction efforts

• Monitor and report on key performance indicators, operational metrics, vendor performance and quality standards to drive continuous improvement

• Collaborate with executive leadership and cross-functional teams to align operational goals with broader business objectives

• Manage audits, corrective action plans, and ensure adherence to internal and external regulatory requirements

• Oversee budgeting, resource allocation, and vendor contract negotiations

• Foster a culture of accountability and execution rigor within assigned departments

• Provide performance management, coaching, and development of team members by modeling Centivo’s leadership skills and behaviors

Qualifications:

• Bachelor’s degree required; advanced degree in appropriate discipline preferred

• 7 years of experience at a third-party administrator, regional or national health plan

• 5 years of experience in an operations role of significant scope

• 5 years of proven leadership experience managing, leading, and coaching teams

• Deep knowledge of self-funded health plans and compliance in the healthcare payer space

• Demonstrated experience leading at least 2 of the operational departments within the scope and proven aptitude and strong interest in leading the others

  • Deep expertise in scaling and efficiency in Call Center operations is strongly preferred

• Demonstrated ability to drive operational improvement and communicate operational needs to internal product teams

• Strong ability to build consensus among stakeholders and cross-functional teams in a dynamic environment

• Familiarity with process management and continuous improvement principles

Leadership Skills:​ 

Business Acumen – A keenness and quickness in understanding and dealing with a business situation (risks and opportunities) in a manner that is likely to lead to a good outcome.  Critical to this is an ability to think beyond their own function.​ 

Accountability & Execution – Taking ownership of actions, following through on commitments, actively carrying out tasks, monitoring progress, delivering results as promised, and being answerable for positive and negative outcomes.  

Strategist Mindset - The ability see and articulate the bigger picture, thinking proactively and anticipating both opportunities and obstacles in the context of setting direction and maintain alignment to long-term company goals. 

Systems Thinking – The ability to see and articulate the patterns, interconnections and interdependencies within a system  

Process Orientation – The ability to see and articulate the sequential flow of activities, including anticipating impacts upstream and downstream when processes are changed.