Senior Manager, Operations

• Oversee multiple operational functions, including membership, enrollment, system support, customer service, claims, and fulfillment
• Lead the Operations Center of Excellence and align operational functions with organizational goals
• Oversee enrollment processes for efficiency, accuracy, and continuous improvement
• Collaborate with cross-functional teams on member acquisition and retention strategies
• Establish quality assurance measures for enrollment data accuracy, completeness, and integrity
• Define KPIs and metrics, analyze data, and drive continuous improvement
• Manage enrollment system vendors and other partners, including service delivery and performance
• Oversee Claims ASO performance guarantees, reviews, approvals, and client RFPs with Sales
• Oversee fulfillment operations and maintain performance and production expectations
• Promote a member-centric culture focused on accuracy, timeliness, issue identification, and root-cause analysis
• Enable the end-to-end Operations value chain through timely and accurate fulfillment
• Design, implement, and manage scalable functional processes
• Pursue process standardization and automation to improve effectiveness, reduce errors, and reduce costs
• Collaborate with Account Implementation, Configuration, and Service leads to address member escalations
• Partner with Continuous Improvement and Vendor Services teams on optimization and sourcing opportunities using Lean-Six Sigma methodologies
• Collaborate with enterprise business partners, including Sales and Digital Services, to determine solutions and address concerns
• Partner with operational leads and workforce management on budgets, staffing models, and performance standards
• Approve business and technical requirements, oversee initiatives, and prioritize decisions
• Resolve complex escalations and contribute to training development
• Manage end-to-end inventory according to regulatory and processing guidelines and timeliness expectations
• Report operational updates to the Claims AVP and Health Plan Operations VP
• Serve as a subject matter expert for ASO Group Operations

• Bachelor's degree or advanced degree (where required), or 10+ years of experience in related field in lieu of degree
• 8+ years of experience in a related field
• Extensive experience in health plan claims, membership, and customer service operations strongly preferred
• Strong understanding of end-to-end health plan operational processes strongly preferred
• Demonstrated analytical and strategic problem-solving skills strongly preferred
• Experience leading transformational, consumer-focused improvements while balancing operational excellence strongly preferred
• Experience applying Six Sigma, Lean, or continuous improvement methodologies strongly preferred
• Experience with Facets claims and membership processing systems preferred
• Authorization to work in the United States

Demonstrates expertise in overseeing operational functions within health plan environments, focusing on membership, enrollment, and claims management. Proficient in applying Lean-Six Sigma methodologies to drive continuous improvement and operational excellence.

• Health Plan Claims Management
• Lean-Six Sigma Methodologies
• Enrollment Process Optimization
• Data Analysis and KPI Definition
• Customer Service Operations

• Operational Process Improvement
• Data Analysis
• KPI Development
• Claims Processing
• Membership Management
• Continuous Improvement Methodologies
• Process Standardization
• Vendor Management
• Root-Cause Analysis
• Fulfillment Operations

• Strategic Problem-Solving
• Collaboration
• Leadership
• Communication
• Issue Identification

• Health Plan Operations
• Member Acquisition
• Customer Retention
• Quality Assurance
• Operational Excellence

• Facets Claims System