Operations Manager

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Operations Manager / Senior Operations Manager Job Description –  Healthcare Programs

Job Summary

The Operations Manager / Senior Operations Manager is responsible for leading and managing day-to-day operations for U.S. healthcare contact center programs while ensuring achievement of client, operational, financial, quality, compliance, and customer experience objectives. This role oversees multiple teams, Team Leaders, Supervisors, SMEs, and support functions to drive operational excellence, workforce performance, regulatory compliance, and continuous business improvement.

The position serves as a strategic partner to clients and internal stakeholders, ensuring successful delivery of healthcare services across Medicare, Medicaid, Marketplace, Commercial Health Plans, Managed Care, Provider Services, Claims, Grievance & Appeals, Enrollment, and Member Services programs.

The ideal candidate possesses strong healthcare operations expertise, leadership capabilities, client management experience, and a deep understanding of healthcare regulations, contact center operations, and performance management.

Key Responsibilities

Operations Leadership & Management

• Lead and manage healthcare contact center operations to achieve client, business, and operational objectives.
• Oversee Team Leaders, Supervisors, SMEs, Coaches, and frontline staff to ensure service delivery excellence.
• Drive performance against key operational metrics, including service level, quality, customer satisfaction, productivity, attendance, compliance, and financial targets.
• Develop and execute operational strategies to improve efficiency, customer experience, and business outcomes.
• Ensure effective workforce utilization and resource planning in partnership with Workforce Management teams.
• Manage operational risks and proactively implement mitigation strategies.

Client & Business Relationship Management

• Serve as a primary point of contact for client stakeholders regarding operational performance, service delivery, and business initiatives.
• Participate in client governance meetings, business reviews, operational reviews, and strategic planning sessions.
• Build and maintain strong client relationships through consistent communication and performance management.
• Present operational results, action plans, performance trends, and improvement initiatives to clients and senior leadership.
• Support new business implementations, transitions, expansions, and program launches.

Performance Management & Employee Development

• Lead, coach, and develop Team Leaders, Supervisors, SMEs, and support staff.
• Establish clear performance expectations and accountability measures across operational teams.
• Conduct regular performance reviews, coaching sessions, talent assessments, and succession planning activities.
• Identify leadership development opportunities and create growth plans for high-potential employees.
• Foster a culture of engagement, accountability, collaboration, and continuous learning.
• Drive employee retention, recognition, and development initiatives.

Quality, Compliance & Regulatory Oversight

• Ensure compliance with HIPAA Privacy and Security regulations, CMS requirements, Fraud, Waste & Abuse (FWA) standards, and client-specific policies.
• Oversee quality assurance programs and performance improvement initiatives.
• Monitor compliance risks and implement corrective actions as necessary.
• Ensure operational readiness for audits, regulatory reviews, and client assessments.
• Partner with Compliance, Quality, Training, and Risk Management teams to maintain regulatory adherence.
• Promote a culture of compliance and ethical business practices throughout operations.

Financial & Business Performance Management

• Manage operational budgets, staffing plans, productivity initiatives, and cost optimization strategies.
• Analyze operational and financial performance metrics to identify opportunities for improvement.
• Ensure achievement of revenue, margin, productivity, and cost-management objectives.
• Monitor staffing requirements and collaborate with Workforce Management to optimize scheduling and capacity planning.
• Drive operational efficiencies while maintaining quality and customer satisfaction standards.

Escalation & Customer Experience Management

• Oversee resolution of high-level member, provider, client, and operational escalations.
• Ensure timely resolution of grievances, complaints, appeals, and regulatory concerns.
• Monitor customer experience metrics and implement initiatives to improve member and provider satisfaction.
• Support root-cause analysis and corrective action planning for recurring operational issues.
• Partner with leadership teams to enhance customer experience and service delivery.

Continuous Improvement & Strategic Initiatives

• Lead process improvement projects utilizing operational best practices and performance data.
• Analyze trends, identify operational gaps, and implement solutions that improve efficiency and effectiveness.
• Support automation, digital transformation, and business optimization initiatives.
• Collaborate with cross-functional teams including Workforce Management, Training, Quality, IT, Compliance, Human Resources, and Client Services.
• Lead special projects, pilot programs, and organizational initiatives as assigned.

Reporting & Analytics

• Monitor and analyze operational dashboards, scorecards, and key performance indicators.
• Prepare and present executive-level operational reports and business reviews.
• Utilize data-driven insights to support strategic decision-making and operational planning.
• Track and communicate performance trends, risks, opportunities, and action plans to leadership and clients.
• Ensure accuracy and integrity of operational reporting and business metrics.

Additional Responsibilities

• Support Annual Enrollment Period (AEP), Open Enrollment, and healthcare seasonal business initiatives.
• Participate in business continuity planning and operational risk management activities.
• Represent operations during client meetings, audits, and strategic planning sessions.
• Perform additional duties and responsibilities as assigned by senior leadership.

Required Qualifications

Experience

• Minimum 5 years of experience in healthcare contact center operations, healthcare BPO, managed care, health insurance, or healthcare services environments.
• Minimum 3 years of leadership experience managing supervisors, team leaders, or operational teams.
• Experience supporting Medicare, Medicaid, Marketplace, Commercial Health Plans, Managed Care, Provider Services, Claims, Enrollment, Member Services, or Grievance & Appeals programs.
• Experience managing large-scale healthcare operations and client-facing business relationships.
• Proven experience driving operational performance and achieving service delivery goals.

Knowledge

Strong understanding of U.S. healthcare industry concepts, regulations, and operational practices.

Working knowledge of:

• HIPAA Privacy and Security Regulations
• CMS Guidelines and Medicare Requirements
• Fraud, Waste & Abuse (FWA)
• Healthcare Compliance Standards
• Grievance and Appeals Processes
• Health Insurance Products and Member Services
• Contact Center Operations and Workforce Management
• Quality Assurance and Performance Management Methodologies

Understanding of healthcare operational metrics, customer experience management, financial performance, and business process improvement.

Skills

• Strong leadership and people management capabilities.
• Excellent client relationship and stakeholder management skills.
• Advanced analytical and problem-solving abilities.
• Strong decision-making and strategic planning skills.
• Excellent verbal, written, presentation, and communication skills.
• Ability to lead large teams in a fast-paced, high-volume environment.
• Strong conflict resolution, negotiation, and change management skills.
• Advanced proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, Outlook).
• Experience using CRM systems, reporting platforms, workforce management tools, and operational dashboards.

Preferred Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Management, Public Health, Communications, or a related field; equivalent experience may be considered.
• Master's degree in Business Administration (MBA), Healthcare Administration (MHA), Public Health (MPH), or related field preferred.
• 7+ years of healthcare operations or healthcare BPO leadership experience.
• Experience supporting Medicare Annual Enrollment Period (AEP) and Open Enrollment operations.
• Experience managing multi-site, remote, or global healthcare operations.
• Six Sigma, Lean, Project Management, Healthcare Compliance, or Leadership certifications preferred.
• Experience working with healthcare analytics, reporting, and business intelligence platforms.

Performance Requirements

• Consistently demonstrate strong leadership, professionalism, accountability, and business acumen.
• Maintain compliance with all company, client, HIPAA, CMS, FWA, and regulatory requirements.
• Achieve or exceed operational, financial, quality, customer satisfaction, and compliance goals.
• Demonstrate the ability to lead high-performing teams and develop future leaders.
• Effectively manage client relationships and deliver exceptional service outcomes.
• Drive continuous improvement initiatives that enhance operational performance and customer experience.
• Foster a culture of collaboration, innovation, engagement, and accountability.
• Protect confidential healthcare, client, and company information at all times.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!