Senior Lead of Strategic Operations

PrimeCare Benefits Group, Inc.™; Las Vegas (NV); Remote; USD 120,000 - 160,000; Full time

Job summary

PrimeCare Benefits Group, Inc.™ is seeking a Senior Lead of Strategic Operations to oversee the daily performance of care coordination, referral/authorization, and claims processing. You will manage 10–15 staff, with union representation, and ensure compliance with HIPAA and contracts in a remote setting with occasional onsite needs.

The role requires strategic thinking, strong leadership, and a track record in healthcare operations.

Qualifications

• Bachelor’s degree in a health/ops field is preferred.
• Minimum 3–5 years in healthcare operations or call center leadership.
• Experience with union environments preferred.
• Strong leadership and communication skills.

Responsibilities

• Oversee day-to-day operations of care coordination and claims departments.
• Develop strategies to improve efficiency and service levels.
• Monitor workflows and ensure deadlines are met.
• Ensure HIPAA compliance and contract adherence.
• Lead, coach, and develop a 10–15 person team, including unionized staff.
• Maintain labor relations and support recruitment and onboarding.

Skills

Leadership

Strategic thinking

Operational management

Communication

Problem solving

Education

Bachelor's degree in healthcare administration, business administration, operations management, or related field

Tools

Microsoft Office

Job description

Position Summary

The Senior Lead of Strategic Operations is responsible for overseeing the daily operational performance of the organization's customer service, referral and authorization, and claims processing departments. This leadership role ensures operational efficiency, compliance with service standards, timely processing of referrals, authorizations, and claims, and effective management of departmental staff. The Senior Lead of Strategic Operations supervises approximately 10–15 employees, the majority of whom are union-represented employees, and is responsible for maintaining productive labor relations while ensuring compliance with company policies and collective bargaining agreements. This is a remote position; however, occasional onsite attendance may be required for meetings, trainings, operational needs, or leadership initiatives.

Essential Duties And Responsibilities

Operational Leadership

• Oversee the overall day-to-day operations of the care coordination and claims departments
• Develop and implement operational strategies to improve efficiency, service levels, and departmental performance
• Monitor departmental workflows to ensure operational goals and deadlines are consistently achieved
• Identify operational challenges and implement corrective action plans as needed
• Ensure compliance with company policies, HIPAA regulations, and applicable contractual requirements

Care Coordination & Call Center Oversight

• Manage the Care Coordinator team within the call center environment
• Ensure appropriate staffing and scheduling to maintain operational coverage and service standards
• Monitor call center metrics and performance indicators, including:
• Abandonment rate
• Average speed to answer (ASA)
• Call quality and productivity
• Ensure departmental performance standards are consistently met, including:
• Abandonment rate below 3%
• Average speed to answer below 30 seconds
• Provide training, coaching, performance management, and operational support to Care Coordinators and supervisory staff

Referral & Authorization Management

• Oversee referral and authorization workflows and processing accuracy
• Ensure all referrals and authorizations are processed within 48 hours of receipt
• Monitor turnaround times and implement workflow improvements as necessary
• Resolve escalated referral and authorization concerns from providers, members, and staff

Claims Department Oversight

• Manage claims department operations to ensure timely and accurate claims processing
• Ensure claims adjustments and corrections are completed promptly and accurately
• Monitor claims aging, processing timelines, and productivity metrics
• Collaborate with leadership and vendors regarding claims-related operational concerns

Leadership & Employee Management

• Supervise, mentor, and support approximately 10–15 employees
• Conduct performance evaluations, coaching sessions, and disciplinary actions as appropriate
• Maintain effective working relationships within a union environment and ensure compliance with collective bargaining agreements
• Assist with recruitment, onboarding, and staff development initiatives
• Foster a positive, collaborative, and service-oriented work environment

Performance Expectations

• Maintain call center performance standards, including:
• Average abandonment rate below 3%
• Average speed to answer below 30 seconds
• Ensure all referrals and authorizations are processed within 48 hours of receipt
• Ensure claims processing and adjustments are completed within established turnaround times
• Maintain high levels of accuracy, productivity, and customer satisfaction
• Support operational efficiency and continuous process improvement initiatives

Qualifications

• Bachelor's degree in healthcare administration, business administration, operations management, or related field preferred
• Minimum of 3–5 years of healthcare operations or call center leadership experience required
• Experience managing claims, referrals, authorizations, or healthcare customer service operations preferred
• Prior supervisory or management experience required
• Experience working within a union environment strongly preferred
• Strong leadership, organizational, and problem-solving skills
• Excellent verbal and written communication abilities
• Strong analytical and operational management capabilities
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency with Microsoft Office and operational software systems

Work Environment

• Remote position
• Occasional onsite attendance may be required for meetings, trainings, operational reviews, or other business needs
• Must maintain a secure and professional remote work environment with reliable internet access

Physical Requirements

• Prolonged periods of sitting and computer use
• Frequent communication via phone, video conference, and email
• Ability to work extended hours as operational demands require