Remote Medicare CX Operations Lead

Alignment Health; United States; Remote; USD 71,000 - 106,000; Full time

Job summary

Alignment Health is seeking a Manager, Customer Experience Support Projects to lead strategic operational initiatives across the Customer Experience organization. You will drive scalable improvements in call center performance, first call resolution, and member issue ownership, working through SME partnerships and matrixed project execution.

The role emphasizes cross-functional collaboration, process optimization, and governance to improve CMS metrics, HIPAA compliance, and overall member

Qualifications

• Minimum five (5) years of Call Center or Member Services experience
• Experience leading operational initiatives or managing teams in a compliance-driven industry
• Demonstrated success improving KPIs such as FCR, service level, quality, or member satisfaction
• Experience with Medicare Advantage or Managed Care environment
• Bilingual (English/Spanish) preferred

Responsibilities

• Lead high-impact operational initiatives that improve service level, quality, FCR, member satisfaction, retention, and regulatory compliance
• Translate organizational strategy into structured project plans with defined scope, milestones, owners, metrics, and accountability
• Develop business cases and collaborates with Finance to create ROI analyses for operational enhancements
• Serve as project lead for cross-functional initiatives impacting the Customer Experience organization
• Ensure initiatives are scalable, repeatable, measurable, and sustainable
• Leads enterprise focus on improving first call resolution and reducing repeat contacts
• Analyzes repeat call drivers, transfer patterns, grievance trends, and systemic barriers
• Designs workflow improvements that promote end-to-end issue resolution
• Partners with department leaders to eliminate friction points across systems, policies, and handoffs
• Establishes accountability mechanisms that reinforce ownership behaviors at all levels
• Develop operational standards and service frameworks that embed empathy and caring connections into workflows
• Partners with Training and leadership to align coaching tools, quality scorecards/dashboards, and performance expectations
• Ensure operational processes support compassionate, seamless member interactions
• Reinforces behaviors that reduces member effort and builds trust
• Partners with SMEs across Claims, Enrollment, Provider Relations, Appeals & Grievances, IT, Compliance, Quality, and Workforce Management
• Leads with strong influence and collaboration to drive alignment, remove barriers, and achieve measurable outcomes
• Facilitates structured working sessions to address systemic issues impacting member experience
• Establishes clear accountability matrices (RACI) for operational initiatives
• Escalate barriers requiring executive alignment while maintaining solution ownership
• Defines and monitors KPIs including: FCR, CMS service level standards, quality and documentation accuracy, member satisfaction/CAHPS and Stars, repeat contact rate, call drivers and transfer trends
• Develops executive-level dashboards and performance summaries
• Translates analytics into structured improvement plans
• Identifies emerging risks and mitigations
• Participates in CRM development, optimization, and system implementation initiatives
• Evaluates contact center technology enhancements that improve leadership tools, resolution and efficiency
• Standardizes workflows to reduce variability and improve consistency
• Ensure documentation, training, and adoption plans for new processes
• Aligns operational improvements with scalability and future growth needs
• Ensure operational initiatives align with CMS Call Center Metrics and Medicare Managed Care regulations
• Partners with Compliance and Quality to support audit readiness and monitoring controls
• Reviews grievance and complaint trends to identify systemic gaps
• Designs process controls that reinforce documentation accuracy and HIPAA compliance and regulatory requirements
• May include direct people leadership of Supervisors and/or frontline staff

Skills

Project management

Change management

Stakeholder management

Analytical thinking

Bilingual English/Spanish preferred

Education

High School Diploma or GED

Bachelor’s degree in Healthcare Administration, Business, Operations Management, or related field

Tools

CRM systems

Workforce management tools

Reporting platforms

Microsoft Office Suite

Job description

Alignment Health is seeking a Manager, Customer Experience Support Projects to lead strategic operational initiatives across the Customer Experience organization. You will drive scalable improvements in call center performance, first call resolution, and member issue ownership, working through SME partnerships and matrixed project execution.

The role emphasizes cross-functional collaboration, process optimization, and governance to improve CMS metrics, HIPAA compliance, and overall member