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Role Description

Reporting to the Director of Member and Provider Service, the Operations Manager is responsible for providing operational oversight including compliance, program development, evaluation, and performance monitoring. This role assumes management of and accountability for day-to-day service operations and is the subject matter expert for service operations.

Key Functions/Responsibilities

• Work with Director on development and execution of service strategy
• Identify trends, risks, and opportunities to set strategic direction
• Identify key strategic considerations for efficient workflows, best practices, and service models
• Collaborate with functional leaders to identify initiatives that improve service to members and providers, create efficiencies, and support product growth and health improvement initiatives
• Synthesize information into impactful materials and presentations to facilitate recommendations to the COO and Executive Teams
• Lead business planning efforts for Member and Provider Service
• Effectively work in a matrix environment to accomplish work across multiple teams in the health plan and health system
• Lead meetings, put content into framework, organize people, and drive implementation
• Understand and visualize data, make data-driven decisions, and create reporting
• Develop, implement, and enhance processes to drive overall performance of service initiatives
• Lead implementation projects assigned in accordance with priority
• Develop methodologies and infrastructure to measure the impact of executed initiatives
• Represent Member and Provider Service as the subject matter expert on corporate initiatives
• Make recommendations related to member and provider service impact and operations
• Lead implementation of any resulting work, internal project teams, coordinates communication, training, documentation, and reporting
• Identify, communicate, and escalate issues to the Director of Member and Provider Service on a timely basis
• Independently problem-solve programmatic issues and implement appropriate solutions
• Responsible for ensuring compliance with contractual and regulatory requirements
• Effectively document the components of the programs necessary for compliance with regulatory standards and submission to external agencies
• Represent Member and Provider Service in meetings with external auditors and regulators
• Coordinate and track the completion of regulatory training for all Member and Provider Service staff and responsible vendors
• Develop and oversee the production of regulatory reports and standard KPI reports
• Implement operational enhancements in partnership with Service leadership
• Accountable for timely notification to the Director and Service Manager if operational performance falls below expectations
• Collaborate with Service leadership, CX Analyst, and vendors to identify opportunities for improvement

Supervision Exercised

No direct reports; manages projects in a matrixed environment.

Supervision Received

Weekly supervision with Director of Member and Provider Service.

Qualifications

• Bachelor’s degree
• Project management certification (preferred)
• Masters degree in Business Administration or related field (preferred)
• 5+ years of healthcare/managed care experience
• 5+ years of service center experience or other applicable work experience
• Project management experience preferred
• Pre-employment background check

Competencies, Skills, and Attributes

• Strategic thinker
• Exceptional written and oral communication skills
• Excellent organizational skills and attention to detail
• Ability to interact with all levels of the organization, as well as external stakeholders
• Superior meeting facilitation skills and experience in leading cross-functional teams
• Demonstrated ability to work independently and manage multiple complex projects simultaneously
• Proactive, motivated, and a collaborative team player
• Demonstrated ability to adapt quickly to changing priorities
• Ability to analyze, compile, format, and present data to a variety of stakeholders
• Strong critical thinking, analytical, and problem-solving skills
• Proficiency with MS tools including Word, Excel, PowerPoint, Visio, and MS Project
• Demonstrated ability of managing competing priorities as well as stakeholders with differing objectives/perspectives
• Effective at forming alliances with other departments to develop partnerships and commitment toward completing the project
• Able to negotiate enterprise solutions with other departments that work interdepartmentally

Working Conditions and Physical Effort

• Work is normally performed in a typical interior/office work environment
• Able to perform some work from a remote environment
• Fast-paced environment
• No or very limited physical effort is required
• No or very limited exposure to physical risk
• Regular and reliable attendance is an essential function of the position

Compensation Range

$86,500 - $125,500. This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.

Benefits

• Generous total compensation that includes benefits (medical, dental, vision, pharmacy)
• Merit increases
• Flexible Spending Accounts
• 403(b) savings matches
• Paid time off
• Career advancement opportunities
• Resources to support employee and family wellbeing