About Texicare

Founded in 2023 as a mission-driven health affiliate of Texas Mutual, Texicare was created by a group of seasoned healthcare professionals, and is headquartered in Austin, Texas. 

Texicare is committed to changing the healthcare landscape by providing small businesses with innovative solutions that increase access to easy-to-use, more affordable, quality health care for Texans and their families. Texicare’s vision is to transform the healthcare ecosystem for the better, helping to create a healthier and happier Texas.  Our healthcare plans were designed to be used, to remove barriers to care, to truly make a difference in people’s lives. 

We’re looking for passionate, mission-driven individuals to join us in creating a healthier and happier Texas.

About the role:

We are seeking an experienced and detail-oriented Manager Health Plan Operations to join our team. This role will be responsible for overseeing, optimizing, and ensuring the efficient and compliant day-to-day operations of our health plan. This individual will manage critical operational functions, drive process improvements, and collaborate cross-functionally to achieve strategic business objectives and maintain high standards of service delivery and regulatory adherence.  

In addition to operations management, this role will support the development, documentation and optimization of operational workflows and processes that are used by cross-functional teams across the organization. This includes collaborating with Sales, Network, Product, Finance, Data Analytics, and Technology to align handoffs, accountabilities, and workflow definitions. This role will also support crucial member, provider, broker and employer escalation and issue management to ensure our stakeholders receive the highest level of service from Texicare.  

The ideal candidate will be proactive, thrive in a cross-functional environment, and be able to manage multiple tasks and projects simultaneously. You will report to the Director, Claims & Insurance Operations. 

In this role, you will:

• Manage and optimize various health plan operational areas, which may include claims processing, enrollment and eligibility, provider data management, grievances and appeals, customer experience, and other back-office functions. 
• Establish, monitor, and report on key performance indicators (KPIs) and service level agreements (SLAs) for all managed operational areas. Analyze data to identify trends and implement process enhancements to streamline operations. 
• Develop and implement a robust quality assurance program for customer interactions, including call monitoring, feedback mechanisms, and coaching to ensure adherence to quality standards and regulatory guidelines. 
• Recruit, hire, train, coach, and mentor a team of operational and customer experience staff and supervisors. Foster a culture of accountability, continuous improvement, and high performance. 
• Ensure all operational activities comply with federal and state regulations (e.g., CMS, HIPAA, ACA, state-specific health plan regulations), accreditation standards, and internal policies and procedures. Stay current on changes in healthcare regulations. 

To be successful in this role, you should have:

• A bachelor’s degree or any equivalent combination of education, training, and experience.  
• At least 6 years of progressive experience in health plan operations, customer service within a health plan, or third-party administrator or any equivalent combination of education, training, and experience.  
• At least 2 years of experience in a people leadership role.
• Demonstrated experience managing remote or hybrid teams performing significant operational functions within a health insurance organization (e.g., claims, enrollment, provider services).  
• In-depth knowledge of health plan operations and commercial products, benefit structures, and healthcare regulatory environments. 
• Proven track record of driving process improvements and operational efficiencies. 
• Experience working cross-functionally with internal teams and managing external vendor relationships. 
• Ability to manage multiple priorities and work effectively in a fast-paced environment. 

Location:

Texicare offers a flex-hybrid environment centered around collaboration and connection.  All employees must reside in Texas. Team members living in the Austin area are expected to work from our office at least two days per week. Those based outside the greater Austin area may work remotely within Texas, with occasional travel to Austin as needed. 

Benefits:

• Automatic 4% employer contribution to retirement plan
• 401k plan with 100% match up to 6%
• Flexible time off for vacation, illness, etc.
• Nine paid holidays
• Day one health, Rx, vision, and dental insurance
• Life and disability insurance
• Flexible spending account
• Pet coverage and pet Rx discounts
• Free identity theft protection
• Free 2nd medical opinion service

Texicare is an equal opportunity employer.