Senior Manager, Operations

bcbsnc; North Carolina; Hybrid; USD 90,000 - 130,000; Full time

Job summary

BCBSNC is seeking a Senior Manager of Operations to oversee multiple functions including membership, enrollment, system support, customer service, claims, and fulfillment. You will ensure efficiency and productivity while delivering analytics services across customer segments.

You will lead the Operations Center of Excellence, drive process improvements, and collaborate with cross-functional teams to optimize end-to-end member experiences and data integrity.

Qualifications

• Bachelor’s degree or advanced degree required.
• 8+ years in a related field; in lieu: 10+ years.
• Bonus points for healthcare operations, Six Sigma experience, and vendor management.

Responsibilities

• Direct accountability for Operations Center of Excellence and core functions.
• Oversee enrollment to ensure efficiency and accuracy.
• Collaborate with cross-functional teams on member acquisition and retention.
• Establish QA measures for data accuracy in enrollment.
• Define KPIs and analyze data to drive improvement.
• Manage enrollment system vendors and partner performance.
• Oversee claims performance guarantees and RFPS with Sales.
• Oversee fulfillment operations to meet performance targets.
• Maintain strong member experience alignment and address front-line issues.

Skills

Leadership

Operations

Data analysis

Vendor management

Process improvement

Education

Bachelor's degree

Advanced degree

Tools

Facets claims system

Lean Six Sigma

Job description

Job Description

The Senior Manager, Operations roles is a pivotal in overseeing multiple functions which may include membership, enrollment, system support, customer service, claims, and fulfillment processes. This position ensures efficiency and productivity deliver operational and analytics services across customer segments to improve performance. This role will contribute to differentiated consumer experience by delivering timely, accurate fulfillment through innovative and integrated processes and channels.

This position requires a thorough knowledge of all operational functions supporting a large ASO group including both dedicated and allocated resources. The Senior Manager of Operations specific responsibilities include:

What You’ll Do

• Direct accountability for the successful operation of the Operations Center of Excellence, p rovide leadership for operational functions which may include membership, enrollment, system support, customer s ervice, cl aims, and fulfillment processes ensuring alignment with organizational goals and objectives
• Oversee the enrollment process to ensure efficiency and accuracy while continuously seeking opportunities for process improvement
• Collaborate with cross-functional teams to develop integrated strategies for member acquisition and retention
• Establish and maintain quality assurance measures to ensure data accuracy, completeness, and integrity throughout the enrollment process
• Define key performance indicators (KPIs) and metrics to measure the effectiveness of membership and enrollment initiatives, analyzing data to inform decision-making and drive continuous improvement
• M anage relationships with enrollment system vendors and other partners, overseeing service delivery and vendor performance to ensure optimal outcomes for the organization and members
• Oversee Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
• Oversee fulfillment operations to meet all performance and production expectations
• Maintain strong connection to member experience and front-line challenges to drive member-centric culture of accuracy and timeliness that proactively exposes issues and pursues root causes
• Collaborate with business leads from Operations to enable end-to-end operations value chain aided by timely and accurate fulfillment
• D esign, implement, and manage scalable functional processes that are flexible to resource deployment needs
• Identify and pursue opportunities for process standardization and automation to improve effectiveness, reduce errors and reduce costs
• Collaborate with Account Implementation, Configuration, and Service that leads to identify areas that drive member escalations
• Partner with Continuous Improvement and Vendor Services teams to identify improvement and sourcing opportunities, including process optimization through Lean-Six Sigma methodologies
• C ollaborate with business partners across the Enterprise such as Sales, Digital Services to determine solutions and address concerns to meet corporate objectives and customer needs
• Partner with operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards
• Approve business and technical requirements, oversee initiatives, and prioritize decisions to effectively address evolving business needs
• Resolve complex escalations and contribute to training development to maintain and improve service delivery
• End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations
• Report operational updates to the Claims AVP and Health Plan Operations VP; serve as a subject matter expert for ASO Group Operations

What You Need

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

Bonus Points

• Extensive experience in health plan claims, membership, and customer service operations with a strong understanding of end-to-end processes strongly preferred.
• Demonstrated analytical and strategic problem-solving skills with the ability to lead transformational, consumer-focused improvements while balancing operational excellence strongly preferred.
• Experience applying Six Sigma, Lean, or continuous improvement methodologies to optimize processes, enhance performance, and drive measurable results strongly preferred.
• Experience with Facets claims and membership processing systems preferred

What You’ll Get

• The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and