Director of Operations

Network Health's success is rooted in its mission to create healthy and strong Wisconsin communities. It drives the decisions we make, including the people we choose to join our growing team.

Network Health is seeking a Director of Operations focusing on Dental Administration who will be responsible for developing, coordinating, and leading the operational efforts for the dental line of business at Network Health. This role involves creating and implementing strategies and procedures to optimize internal operations within their area of responsibility, as well as overseeing all operations delegated to first-tier, downstream, and related entities. The Director will establish service level standards aimed at reducing response times and ensuring high customer satisfaction. Additionally, they will develop policies and procedures to ensure high-quality service delivery that reflects industry best practices. The Director will also implement systems to capture and report on key metrics, manage resource planning, and make informed decisions. A deep understanding of dental administration, dental benefits configuration, and the payment of dental claims is essential for success in this role.

Job Responsibilities:

• Demonstrates commitment and behavior aligned with the philosophy, mission, values, and vision of Network Health.
• Ensures adherence to all organizational, regulatory, and credentialing principles, procedures, requirements, regulations, and policies.
• Oversees, evaluates, develops, and implements business and dental operations functions to meet business needs.
• Ensures operational policies and procedures are documented and compliant with regulatory requirements, as well as aligned with the organization's primary goals and objectives.
• Manages all aspects of human resource functions, including hiring, training, performance evaluations, day-to-day management, and terminations.
• Plans, prepares, and justifies the departmental expense and staffing budget to meet the strategic needs of the organization.
• Monitors the approved budget monthly and takes corrective actions for unfavorable variances.
• Oversees the design and execution of education and training programs for employees involved in operational functions, including the creation of training materials for both new and ongoing employee training.
• Manages relationships with first-tier, downstream, and related entities, including vendors and outsourced service providers.
• Maintains effective communication with internal and external stakeholders (e.g., compliance, marketing, sales) to monitor operational efficiency and ensure appropriate resource utilization.
• Directs and manages the division's administrative duties, including organizing documentation, preparing reports, and supervising the operational leadership team.
• Collaborates with staff to develop department and individual performance plans, evaluates progress, and documents achievements.
• Develops succession plans and work plans for managers and oversees the development of similar plans for supervisors and front-line staff.
• Works closely with Compliance to identify changes in relevant rules, regulations, and standards, and updates policies and procedures accordingly.
• Completes data analysis, benchmark comparisons, and reports on performance measures; develops and implements action plans to improve performance as needed.
• Contributes to short- and long-term organizational planning and strategy as a member of the management team.
• Oversees the performance of operations and related initiatives.
• Identifies opportunities for operational efficiencies and develops plans to improve processes, including the creation and maintenance of Key Performance Indicators (KPIs) to monitor performance. Leads corrective action planning for underperforming metrics.
• Focuses on improving operational systems, processes, and policies to support the organization's mission, particularly in areas like reporting, information flow, business processes, and organizational planning.
• Performs other duties as assigned.

Minimum Education Required:

• Bachelor's Degree in business or healthcare administration or related field, or 10 years of equivalent work experience within health care field.
• A master's degree is preferred.

Minimum Related Years of Experience (per minimum education) Required:

• A minimum of at least 5 years management experience in health insurance or related health care industry
• Leadership experience working with the commercial and self-funded, health insurance exchange, Medicaid, Medicare advantage or Dental operations required based on area of support.
• Experience with specific line or lines of business supporting preferred. (Enrollment, claims, TPA services, dental or customer services operational areas)
• Experience working in an audit or process improvement environment preferred.
• Budget development and oversight experience preferred.

Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required), at our office in Brookfield or Menasha, or a combination of both in our hybrid workplace model.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce.