Associate Director, Student Medical Plan and Operations

Strong Internal Identified

A strong internal candidate has been identified.

Salary Grade

Case Western Reserve University is committed to providing a transparent estimate of the salary range available for this position at the time of its posting. The salary range is between $52,705 and $66,672, depending on qualifications, experience, department budgets, and industry data.

Employees receive more than just a paycheck. University employees enjoy a comprehensive benefits package that includes excellent healthcare, retirement plans, tuition assistance, paid time off, and a winter recess.

Job Description

POSITION OBJECTIVE

The Associate Director, Student Medical Plan and Operations will provide strategic and operational oversight of student health administrative services, including student medical and insurance programs, financial and revenue cycle operations, emergency funding, records and compliance, credentialing, and data reporting. This position will ensure efficient, compliant, and student-centered operations through effective vendor and stakeholder partnerships, sound financial management, data-informed decision-making, and continuous process improvement to support access to high-quality health and counseling services.

ESSENTIAL FUNCTIONS

• Manage and oversee all functions related to the Student Medical Plan, Dependent Medical Plan, Athletic Sports Plan, and waiver programs. Serve as the primary operational liaison with third-party administrators, insurance carriers, Case Western Reserve University departments, students, families, and healthcare providers. Manage enrollment processes, waiver requirements, eligibility questions, exceptions, appeals, and insurance-related concerns. Monitor claims activity, utilization trends, payment processes, and operational performance. Establish service standards and identify protocols for office operations. Maintain knowledge of changing healthcare regulations, insurance requirements, and federal compliance standards. Develop, implement, and maintain the communication and marketing plan including orientation programs, written materials, and online information sites for all student customers. Meet with students, parents, school representatives and other stakeholders individually and in groups (orientation) to explain plan benefits. (40%)
• Oversee billing operations, payment processes, reimbursement workflows, and financial procedures related to student health and counseling services. Monitor financial activity, identify trends, and recommend improvements. Review and reconcile all monthly financial statements to ensure expenses are valid and assigned to the correct funding source. Track purchase orders and payment processes. Order office supplies including purchasing products/services. Maintain accurate documentation for budget reconciliation. Support the Senior Director of Operations with department and budget planning, reporting, and financial analysis activities. Partner with leadership to develop sustainable operational processes that support department goals. (25%)
• Manage and oversee university emergency funding processes supporting students with healthcare-related financial needs. Review student requests, documentation, eligibility criteria, and funding recommendations. Ensure consistent application of emergency fund guidelines and maintain appropriate documentation. Collaborate with campus partners to support students experiencing financial barriers to accessing healthcare resources. (10%)
• Oversee medical records operations, release of information processes, documentation workflows, and confidentiality requirements. Ensure compliance with applicable privacy regulations and institutional policies. Develop and maintain operational documentation, workflows, and training resources. (10%)

NONESSENTIAL FUNCTIONS

• Develop and maintain operational reports related to insurance programs, financial activity, student services, and departmental performance. Analyze data trends and provide recommendations to leadership. Use data-driven insights to support strategic planning and continuous improvement. (5%)
• Oversee credentialing process as a part of new hire onboarding procedure and annually thereafter for all licensed providers within the departments. Assist with maintaining accurate employee and department records to facilitate accreditation applications and renewals. (5%)
• Assist with educational, wellness, and outreach events as needed. (2%)
• Collaborate with Student Affairs leadership in special circumstances involving students needing urgent medical or mental health care (2%)
• Perform other duties as assigned. (1%)

CONTACTS

Department: Frequent contact with University Health and Counseling staff and leadership team to provide information and solutions for all insurance questions.

University: Continuous contact with the risk manager department to review various aspects of the student medical plan and student appeals. Regular contact with student medical plan advisory committee including university general counsel and Office of the Provost Sr. Director of Finance. Occasional contact with the associate vice president of student affairs to resolve student appeals and complaints. Moderate contact with the university registrar to obtain eligibility files for medical plan participants. Regular contact with student financials to add/ remove medical plan fee from tuition accounts. Frequent contact with the director of athletics and associate athletic director to review sports claims and resolve coverage questions for student athletes. Frequent contact with athletic trainers to update eligibility and resolve questions and or problems. Moderate contact with University Counseling staff to resolve eligibility issues and answer questions about coverage. Moderate contact with the Dental School to provide files of medical plan participants and resolve student complaints.

External: Moderate contact with the Cleveland Institute of Art IT department to receive files for third party administrator, prescription benefit manager and resolve eligibility problems. Frequent contact with the associate dean Cleveland Institute of Music (frequent) review eligible student lists and bill for participants. Moderate contact with the Cleveland Institute of Music IT department, to receive files for third party administrator, prescription benefit manager and resolve eligibility problems. Continuous contact with the third-party administrator to resolve problems with claims, review appeals and resolve student complaints, collaborate on student medical plan marketing materials, and review updates in the insurance industry. Continuous contact with account representative/prescription benefit manager to resolve eligibility problems, student complaints and access problems. Continuous contact with parents of Case Western Reserve University students to explain student medical plan coverage, answer questions, and resolve problems.

Students: Continuous contact with students regarding enrollment, questions, waiver, and claims assistance

SUPERVISORY RESPONSIBILITIES

Oversee the work of the student medical plan department assistant.

QUALIFICATIONS

Experience: 3 or more years of progressive experience in healthcare operations, revenue cycle management, insurance administration, business operations, compliance, or healthcare leadership required. Experience managing healthcare operations within an academic or complex healthcare environment. Experience with student health insurance administration preferred.

Education: Bachelors degree in healthcare administration, Business Administration, Public Health, Finance, or related field required. Masters degree in business administration (MBA), Healthcare Administration, or related field preferred.

REQUIRED SKILLS

• Demonstrated knowledge of healthcare operations, insurance administration, and student health insurance programs.
• Comprehensive understanding of healthcare regulations, insurance requirements, revenue cycle processes, and compliance standards, including HIPAA and confidentiality requirements.
• Strong financial management skills, including budgeting, financial analysis, reconciliation, reporting, and operational performance monitoring.
• Ability to analyze complex operational and financial data, identify trends, and develop data-driven recommendations to improve efficiency and service delivery.
• Proven leadership and supervisory skills with the ability to coach, develop, and evaluate staff while fostering collaboration and accountability.
• Experience leading operational initiatives, process improvement efforts, workflow optimization, and organizational change management.
• Strong project management and organizational skills with the ability to manage multiple priorities, deadlines, and competing demands.
• Excellent problem-solving and critical thinking skills with the ability to resolve complex operational, financial, and customer service issues.
• Exceptional written, verbal, and presentation communication skills, with the ability to communicate complex insurance and healthcare information to a variety of audiences.
• Demonstrated ability to build and maintain collaborative relationships with internal and external stakeholders, including healthcare providers, insurance carriers, third-party administrators, university leadership, students, and families.
• Strong customer service orientation with a commitment to delivering responsive, student-centered services.
• High degree of professionalism, discretion, and sound judgment in handling confidential and sensitive information.
• Proficiency with Microsoft Office applications, healthcare information systems, financial reporting tools, and data management software.
• Ability to interpret policies, regulations, and contractual agreements and apply them consistently to operational decision-making.
• Willingness to learn and effectively utilize artificial intelligence (AI) tools and emerging technologies to improve operational effectiveness.
• Ability to demonstrate successful support, education, and advocacy for all students, aligned with the values, mission, and messaging of the university, while adhering to the staff policy on conflict of commitment and interest.
• Ability to maintain regular, reliable attendance and effectively interact with colleagues, supervisors, students, families, and external partners in person and through multiple communication platforms. Willingness to learn and work with artificial intelligence (AI) tools and technologies.
• Ability to demonstrate successful support, education, and advocacy for all students, aligned with the values, mission, and messaging of the university, while adhering to the staff policy on conflict of commitment and interest.
• Ability to meet consistent attendance.
• Ability to interact with colleagues, supervisors, and customers face to face.

WORKING CONDITIONS

Standard Health and Counseling offices in a university campus setting.

Full-time professionals are exempt from overtime and are expected to work a minimum of 40 hours per week around the universitys core hours of operation. This position may be eligible for hybrid work after successful completion of orientation period.

Hybrid Eligibility

This position is eligible for hybrid work arrangement up to two remote days per week at the discretion of the department. New employees may begin a hybrid schedule upon approval from the supervisor, successful completion of an orientation period and signing the remote work checklist certification form.

EEO Statement

Case Western Reserve University is an equal opportunity employer. All applicants are protected under federal and state laws and university policy from discrimination based on race, color, religion, sex, sexual orientation, gender identity or expression, national or ethnic origin, protected veteran status, disability, age and genetic information.

Reasonable Accommodations

Case Western Reserve University complies with the Americans with Disabilities Act regarding reasonable accommodations for applicants with disabilities. Applicants requiring a reasonable accommodation for any part of the application and hiring process should contact the CWRU Office of Equity at 216-368-3066 to request a reasonable accommodation. Determinations as to granting reasonable accommodations for any applicants will be made on a case-by-case basis.

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