Operations Officer at San Francisco Health Plan – San Francisco, California

Reporting to the Chief Operating Officer, the Operations Officer (OO) contributes to strategic planning for San Francisco Health Plan. You have the authority to enhance the internal organizational processes and infrastructure to allow San Francisco Health Plan (SFHP) to grow and fulfill our mission. You will collaborate with the Chief Operating Officer in implementing our strategic goals by partnering with peer executives. The OO oversees the following functions: Customer Service, Claims, Grievances & Appeals, Eligibility Management, and Business Solutions (QNXT Configuration and Business Systems Analysis).

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $240,000 to $260,000 annual

WHAT YOU WILL DO:

• Develop and execute operations roadmap to meet organizational long-term goals within the Customer Service, Member Eligibility Management, Claims and Business Solutions Departments at SFHP.
• Own operating model design: org structure, staffing plans, capacity models, performance targets, escalation paths.
• Lead annual forecasting, productivity plans, cost-of service, and other KPIs to optimize initiatives. Establish expectations to be implemented by the departments.
• Responsible for the accurate and timely reporting of information and documentation to executive staff and board of directors.
• Drive continuous improvement initiatives to enhance operational efficiency, provider and member experience.
• Motivate staff and take necessary steps to ensure that outstanding service is always provided to both internal and external customers.
• Partner with Compliance and Audit Teams to address operational compliance with all levels of regulatory agencies.
• Lead and mentor senior operational leaders. Support workforce planning, succession planning, and other talent development initiatives.
• Collaborate with cross-functional teams to further organizational goals.

WHAT YOU WILL BRING:

• Minimum of a BA, ideally with an applicable advanced degree (MBA, CPA, MPA, MPH) preferred.
• 10+ years of experience leading health plan operations, including claims, customer service, grievance and appeals, QNXT configuration and business systems analysis.
• 8+ years of progressively increasing leadership responsibilities.
• Knowledge of California health care structure, especially government-subsidized care.
• Demonstrated experience in financial planning and analysis.
• Skills should include organizational development, succession planning, budget and resource development, and strategic planning; demonstrated success developing and monitoring systems to manage both operational and programmatic work that involve high levels of collaboration.

WHAT WE OFFER:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)

Reporting to the Chief Operating Officer, the Operations Officer (OO) contributes to strategic planning for San Francisco Health Plan. You have the authority to enhance the internal organizational processes and infrastructure to allow San Francisco Health Plan (SFHP) to grow and fulfill our mission. You will collaborate with the Chief Operating Officer in implementing our strategic goals by partnering with peer executives. The OO oversees the following functions: Customer Service, Claims, Grievances & Appeals, Eligibility Management, and Business Solutions (QNXT Configuration and Business Systems Analysis).

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $240,000 to $260,000 annual

WHAT YOU WILL DO:

• Develop and execute operations roadmap to meet organizational long-term goals within the Customer Service, Member Eligibility Management, Claims and Business Solutions Departments at SFHP.
• Own operating model design: org structure, staffing plans, capacity models, performance targets, escalation paths.
• Lead annual forecasting, productivity plans, cost-of service, and other KPIs to optimize initiatives. Establish expectations to be implemented by the departments.
• Responsible for the accurate and timely reporting of information and documentation to executive staff and board of directors.
• Drive continuous improvement initiatives to enhance operational efficiency, provider and member experience.
• Motivate staff and take necessary steps to ensure that outstanding service is always provided to both internal and external customers.
• Partner with Compliance and Audit Teams to address operational compliance with all levels of regulatory agencies.
• Lead and mentor senior operational leaders. Support workforce planning, succession planning, and other talent development initiatives.
• Collaborate with cross-functional teams to further organizational goals.

WHAT YOU WILL BRING:

• Minimum of a BA, ideally with an applicable advanced degree (MBA, CPA, MPA, MPH) preferred.
• 10+ years of experience leading health plan operations, including claims, customer service, grievance and appeals, QNXT configuration and business systems analysis.
• 8+ years of progressively increasing leadership responsibilities.
• Knowledge of California health care structure, especially government-subsidized care.
• Demonstrated experience in financial planning and analysis.
• Skills should include organizational development, succession planning, budget and resource development, and strategic planning; demonstrated success developing and monitoring systems to manage both operational and programmatic work that involve high levels of collaboration.

WHAT WE OFFER:

• Health Benefits
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  • Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)