Job Description

Executive Opportunity – Chief Operating Officer (COO)

Location: Onsite (Daily Office Presence Required)

We are seeking an experienced Chief Operating Officer (COO) to lead operations for a growing Third-Party Administrator (TPA) supporting self-funded health plans . This executive leadership role will report directly to the CEO and be responsible for operational excellence, vendor management, regulatory compliance, and strategic growth initiatives.

What You’ll Lead

• Claims Administration
• Eligibility & Enrollment Operations
• Member & Employer Group Services
• Billing & Reconciliation
• Operational Performance & Continuous Improvement
• Drive day-to-day operational execution across all TPA functions.
• Establish and monitor KPIs including claims turnaround, accuracy, service levels, and operational efficiency.
• Oversee relationships with stop-loss/reinsurance carriers, PBMs, provider networks, utilization management vendors, actuaries, and technology partners.
• Lead contract negotiations, SLA management, and vendor performance reviews.
• Partner with finance, actuarial, and clinical teams to manage healthcare costs, trends, and risk exposure.
• Ensure compliance with ERISA, ACA, HIPAA, COBRA, and applicable regulations.
• Develop scalable processes, controls, and operational roadmaps to support growth.
• Provide executive reporting and strategic recommendations to the CEO and Board.

Qualifications & Experience

• Experience working within a TPA supporting self-funded employer groups
• Direct experience managing stop-loss/reinsurance carriers and PBMs
• Senior leadership experience (Director, VP, or C-Level) in healthcare benefits administration, TPAs, or self-funded health plans
• Deep understanding of claims administration, eligibility, enrollment, and self-funded plan operations
• Strong knowledge of ERISA, ACA, HIPAA, and COBRA regulations
• Proven vendor management and contract negotiation expertise
• Demonstrated success building scalable operational organizations
• Experience implementing or migrating claims administration platforms
• Knowledge of reference-based pricing and cost-containment strategies
• Experience working with brokers, consultants, and employer groups
• Experience scaling a TPA through growth or acquisition

Core Competencies

• Operational Excellence
• Strategic Leadership
• Financial & Risk Management
• Regulatory Compliance
• Data-Driven Decision Making
• Client & Stakeholder Management

This is an outstanding opportunity for a proven healthcare operations leader to make a significant impact within a growing organization serving self-funded employer groups.

Job Tags

Similar Jobs