Health Plan Operations Lead

Be a part of the team building the future of healthcare!

Firefly Health is building a revolutionary new type of comprehensive health "care and coverage,” powered by a relationship-driven care team, a trusted virtual and in-person clinical network, and our proprietary technology platform.

Founded by experienced clinicians and technology leaders, Firefly Health is on a mission to deliver clinical and financial health through joyful, always there care. We are flipping the script on what it means to be a health plan and actually providing a true health benefit to members.

We are intensely focused on optimizing the physical + mental + financial wellbeing of those who want (and deserve) something better than the status quo. If you are ready to roll up your sleeves and take on our audacious mission, we would love to hear from you.

Your Role

We are seeking a highly motivated and detail-oriented Health Plan Operations Lead with experience at early-stage, tech-enabled, health care companies. This role is ideal for someone with a strong background in product-focused health operations, with a preference for experience in value-based care (VBC), third-party administrators (TPAs), and/or complex care navigation environments. The Health Plan Operations Lead will play a pivotal role in building an exceptional health plan team from the ground up. We are seeking candidates who love rolling up their sleeves, digging into data, and collaborating cross-functionally to deliver seamless health plan operations and drive the implementation and enhancement of innovative product solutions for our clients and members.

You will:

• Operational Oversight:
• Build, manage and optimize end-to-end health plan operations processes, including enrollment, claims, billing, and customer support.
• Coordinate with key stakeholders (internal and external) to ensure seamless operations and alignment with product strategy and business objectives.
• Implement and execute standard operating procedures (SOPs) and key performance indicators (KPIs) with internal and external stakeholders.
• Vendor and Partner Management:
• Oversee day-to-day relationships with third-party vendors and partners, ensuring service level agreements (SLAs) are met.
• Work closely with network providers, care delivery systems, and other external partners to develop and maintain processes that support operational efficiency and product integrations.
• Process Improvement:
• Identify and implement improvements in workflows, focusing on tech-driven solutions to increase operational efficiency and accuracy.
• Define and implement standard operating procedures with Sales, Customer Success, Network and Clinical teams that deliver a shared understanding and define requirements to deliver an exceptional health plan customer experience.
• Collaborate with Product and Engineering teams to define requirements for operational tools and processes, ensuring that the health plan operations team has the tools needed for scalable, high-quality service delivery.
• Data Analysis and Reporting:
• Utilize data analytics to define and monitor key metrics, performance, and outcomes, identifying areas for improvement and proposing actionable solutions.
• Create and present regular reports on operational metrics, vendor performance, and overall plan performance.
• Regulatory Compliance:
• Ensure all operational activities align with regulatory requirements and industry best practices, particularly for self-funded and fully insured health plans, and value-based care products.
• Support audits, reporting, and other compliance activities as needed to ensure the company’s adherence to applicable standards.

You’d be a good fit if you have:

• 5+ years in health plan operations or a related role, preferably within a value-based care, TPA, or care navigation company.
• Background in tech-enabled, early-stage companies with a focus on innovative process design, cross-functional collaboration, and product innovation.
• Hands-on experience working with 3rd party partners/vendors and health plan product teams, translating operational needs into product requirements and solutions.
• Strong project management skills, with a proven track record of successfully managing complex, multi-stakeholder initiatives.
• Data-driven mindset, with experience in data analysis, reporting, and performance improvement initiatives.
• Excellent interpersonal and communication skills, with an ability to collaborate effectively across departments and with external partners.
• Familiarity with healthcare operations tools (e.g., claims processing systems, CRM, analytics platforms) and a comfort level with tech-enabled solutions.

It’d be nice if you have:

• Advanced proficiency in business intelligence systems (e.g., Looker) and familiarity with SQL or other data query tools is a plus.

Our office is in Watertown, Massachusetts, but we’ve developed a robust remote working structure to give us more geographical flexibility while hiring for many positions. This role can be done largely remotely, there are several times a year when staff come together onsite for planning and team building.  

Firefly is an equal opportunity employer. We value diverse backgrounds and perspectives. We're committed to building and sustaining an inclusive workplace culture where individuals are treated with dignity and respect. All employment is decided on the basis of qualifications, merit, and business need. Firefly is an E-Verify employer.

We are always looking for valuable talent to add to our growing team. Even if you’re not sure this role is the one for you, don’t let that stop you. We’d love to have a conversation to see where you could fit.