Senior Manager, Operations

Direct accountability for the successful operation of the Operations Center of Excellence, provide leadership for operational functions which may include membership, enrollment, system support, customer service, claims, and fulfillment processes ensuring alignment with organizational goals and objectives 

Oversee the enrollment process to ensure efficiency and accuracy while continuously seeking opportunities for process improvement 

Collaborate with cross-functional teams to develop integrated strategies for member acquisition and retention 

Establish and maintain quality assurance measures to ensure data accuracy, completeness, and integrity throughout the enrollment process  

Define key performance indicators (KPIs) and metrics to measure the effectiveness of membership and enrollment initiatives, analyzing data to inform decision-making and drive continuous improvement  

Manage relationships with enrollment system vendors and other partners, overseeing service delivery and vendor performance to ensure optimal outcomes for the organization and members 

Oversee Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization 

Oversee fulfillment operations to meet all performance and production expectations  

Maintain strong connection to member experience and front-line challenges to drive member-centric culture of accuracy and timeliness that proactively exposes issues and pursues root causes 

Collaborate with business leads from Operations to enable end-to-end operations value chain aided by timely and accurate fulfillment  

Design, implement, and manage scalable functional processes that are flexible to resource deployment needs 

Identify and pursue opportunities for process standardization and automation to improve effectiveness, reduce errors and reduce costs 

Collaborate with Account Implementation, Configuration, and Service that leads to identify areas that drive member escalations  

Partner with Continuous Improvement and Vendor Services teams to identify improvement and sourcing opportunities, including process optimization through Lean-Six Sigma methodologies 

Collaborate with business partners across the Enterprise such as Sales, Digital Services to determine solutions and address concerns to meet corporate objectives and customer needs 

Partner with operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards 

Approve business and technical requirements, oversee initiatives, and prioritize decisions to effectively address evolving business needs 

Resolve complex escalations and contribute to training development to maintain and improve service delivery 

End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations 

Report operational updates to the Claims AVP and Health Plan Operations VP; serve as a subject matter expert for ASO Group Operations 

Extensive experience in health plan claims, membership, and customer service operations with a strong understanding of end-to-end processes strongly preferred.

Demonstrated analytical and strategic problem-solving skills with the ability to lead transformational, consumer-focused improvements while balancing operational excellence strongly preferred.

Experience applying Six Sigma, Lean, or continuous improvement methodologies to optimize processes, enhance performance, and drive measurable results strongly preferred.

Experience with Facets claims and membership processing systems preferred