Client Provider Operations

Position Summary

We are seeking experienced Provider Operations Partner to lead the stabilization, optimization, and operational management of Provider Core Services. This leader will be responsible for ensuring business continuity, improving provider data quality, enhancing operational efficiency, and driving provider-related initiatives across a national healthcare organization.

The ideal candidate will bring deep expertise in Provider Data Management, Provider Operations, Claims, Credentialing, Contracting, and Healthcare Payer Operations, with the ability to engage senior executives and influence cross-functional stakeholders.

Key Responsibilities

• Lead day-to-day Provider Core Services operations, ensuring service stability and operational excellence.
• Drive provider data accuracy, governance, and quality improvement initiatives.
• Oversee provider credentialing, provider contracting, and provider onboarding processes.
• Partner with business leaders, Plan Presidents, Operations Executives, and Provider Network leadership to address operational challenges and improve provider experience.
• Identify and resolve operational bottlenecks impacting provider and claims processes.
• Establish performance metrics, service levels, and accountability frameworks.
• Lead large teams responsible for provider data management and provider servicing functions.
• Collaborate with technology teams to improve workflows and drive automation opportunities.
• Ensure regulatory compliance and operational readiness across provider functions.

Required Qualifications

• 15+ years of healthcare payer experience.
• Deep expertise in:
  • Provider Data Management
  • Provider Operations
  • Claims Operations
  • Provider Credentialing
  • Provider Contracting
• Strong operational leadership background.
• Experience leading large, distributed healthcare operations teams.
• Proven ability to work directly with C-suite executives, Plan Presidents, and senior business stakeholders.
• Strong communication, executive presentation, and stakeholder management skills.
• Ability to drive execution and deliver measurable outcomes.

Preferred Qualifications

• Experience with provider data platforms and provider lifecycle management solutions.
• Knowledge of healthcare provider network expansion strategies.
• Experience leading large-scale operational transformation programs.