Senior Manager, Operations

Jobtailor; Alabama; On-site; USD 90,000 - 120,000; Full time

Job summary

Jobtailor is seeking an experienced Operations leader to oversee membership, enrollment, system support, customer service, claims, and fulfillment within health plan operations in Alabama. You will lead the Operations Center of Excellence and drive end-to-end process improvements to align with organizational goals.

Candidates should bring 8+ years in health plan operations, strong Lean-Six Sigma experience, and a track record of cross-functional collaboration.

Qualifications

• Bachelor's degree or 10+ years of related field experience 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.

Responsibilities

• 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

Skills

Enrollment optimization

Lean-Six Sigma

Data analysis

Process improvement

Leadership

Education

Bachelor's degree

Advanced degree

10+ years experience (in lieu of degree)

Tools

Facets Claims System

Job description

• 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

Requirements

• 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

Core Competencies

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.

Highest-signal resume keywords

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

ATS Optimization Keywords

Hard Skills

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

Soft Skills

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

Industry Keywords

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

Tools & Technologies

• Facets Claims System