IntroductionAt Gallagher, we help clients face risk with confidence because we believe th when businesses are protected, they’re free to grow, lead, and innove. You’ll be backed by our digital ecosystem: a client-centric suite of consulting tools making it easier for you to meet your clients where they want to be met. Advanced da and analytics providing a comprehensive overview of the risk landscape is your fingertips. Here, you’re not just improving clients' risk profiles, you’re building trust. You’ll find a culture grounded in teamwork, guided by integrity, and fueled by a shared commitment to do the right thing. We value curiosity, celebre new ideas, and empower you to take ownership of your career while making a meaningful impact for the businesses we serve. If you’re ready to bring your unique perspective to a place where your work truly mters; think of Gallagher.
OverviewJoin VEBA Direct, a groundbreaking DMHC-approved pilot program in California, as the Director of TPA Operions. This role is your opportunity to lead, scale, and professionalize the operional oversight of our Third Party Administror (TPA) relionship. You’ll ensure our innovive employer-direct model operes efficiently, compliantly, and better than traditional health plans.
How you'll make an impactIn this role, you’ll take full ownership of TPA operions, driving vendor performance, compliance, and operional excellence. You’ll lead new client implementions, manage complex projects, and ensure seamless transitions into steady-ste operions. By optimizing processes and enabling scalability, you’ll position VEBA Direct for growth and success. You’ll also act as a trusted partner to internal teams, provider medical groups, and external stakeholders, ensuring alignment and collaborion.
Key Responsibilities
TPA & Deleged Vendor Oversight
- Own the day‑to‑day operional relionship with the Third‑Party Administror, ensuring performance meets contractual obligions, service levels, and regulory requirements.
- Provide oversight of all subcontracted and deleged functions performed by the TPA, including performance monitoring, issue escalion, root cause analysis, and continuous improvement.
- Ensure ongoing compliance with DMHC requirements and deleged model standards.
- Maintain audit readiness and lead operional support for regulory reviews, audits, and inquiries.
- Hold vendors accountable through da‑driven performance management and documented remediion plans.
Implemention & Project Leadership
- Lead all new client implementions, expansions, and operional changes across the VEBA Direct book of business.
- Serve as the operional owner for implemention planning and execution, including:
- Master project plans and timelines
- Da migrion and system integrions
- Testing, validion, and readiness assessments
- Regulory and contractual compliance checkpoints
- Risk identificion, mitigion, and issue management
- Partner with internal teams, the TPA, and external stakeholders to establish realistic milestones and Go‑Live des, ensuring delivery against commitments.
- Ensure seamless transition of accounts from implemention into steady‑ste operions.
Operional Excellence & Scalability
- Monitor and analyze operional performance metrics to identify opportunities for increased efficiency, accuracy, and scalability.
- Lead process optimizion and technology enablement initiives to support growth, new products, and evolving regulory requirements.
- Identify system enhancements and workflow improvements across deleged operional functions.
Client, Provider & Stakeholder Engagement
- Act as a highly visible internal and external operional leader and trusted partner to the TPA, provider medical groups, and internal teams.
- Serve as the primary operional contact for PMG onboarding in partnership with the Network Manager.
- Lead internal and external project meetings; develop agendas, document decisions, and track action items to completion.
- Advise internal stakeholders and vendor partners on operional best practices, system capabilities, staffing models, and workflow design.
Documention, Training & Governance
- Develop and maintain comprehensive operional and project documention, including:
- Project plans and stus reporting
- Risk and issue logs
- Communicion and change management plans
- Integrion and technology documention
- Go‑Live merials and acceptance deliverables
- Cree executive‑ready reports, presentions, process flows, program manuals, and training merials.
- Plan and facilite training sessions for internal teams, clients, and vendor partners (virtual and onsite as needed).
- Support the development, implemention, and enforcement of operional policies and procedures in alignment with leadership direction.
About YouHere’s wh you’ll bring to the role:
- 10+ years of experience in health plan operions, with expertise in deleged models and TPA oversight.
- Hands-on knowledge of claims, eligibility, provider management, and other core operional functions.
- Proven ability to lead complex implementions in reguled environments.
- Strong skills in contract interpretion, vendor accountability, and stakeholder management.
- A bachelor’s degree (required); a master’s degree (MBA, MPH, or reled field) is preferred.
- A proactive, organized, and collaborive approach to problem-solving and execution.
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Compension and benefitsWe offer a competitive and comprehensive compension package. The base salary range represents the anticiped low end and high end of the range for this position. The actual compension will be influenced by a wide range of factors including, but not limited to previous experience, educion, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, gre teams and exciting career opportunities, we also offer a wide range of benefits.
Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:
- Medical/dental/vision plans, which start from day one!
- Life and accident insurance
- 401(K) and Roth options
- Tax-advantaged accounts (HSA, FSA)
- Educional expense reimbursement
- Paid parental leave
Other benefits include:
- Digital mental health services (Talkspace)
- Flexible work hours (availability varies by office and job function)
- Training programs
- Gallagher Thrive program – eleving your health through challenges, workshops and digital fitness programs for your overall wellbeing
- Charitable mching gift program
- And more...
**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.
We value inclusion and diversity
Click Here to review our U.S. Eligibility Requirements
Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organizion. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.
Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.
Gallagher believes th all persons are entitled to equal employment opportunity and prohibits any form of discriminion by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy stus), sexual oriention, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital stus, parental stus, age, nional origin, ancestry, disability, medical condition, genetic informion, veteran or military stus, citizenship stus, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, ste, or local laws.
Equal employment opportunity will be extended in all aspects of the employer-employee relionship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compension, benefits, layoff, and terminion. In addition, Gallagher will make reasonable accommodions to known physical or mental limitions of an otherwise qualified person with a disability, unless the accommodion would impose an undue hardship on the operion of our business.
