Senior Manager, Operations

Blue Cross NC

Senior Operations Manager overseeing health-plan claims, enrollment, membership, and fulfillment operations at Blue Cross NC. Driving analytics, process improvement, vendor performance, and member experience.

Posted 8/20/2026full-timeDurham • Alabama, Arizona, Colorado, Florida, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Montana, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming • 🇺🇸 United StatesSenior💰 $130,560 - $208,896 per yearWebsite

Core Competencies

Role fit

Core Competencies

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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 ManagementLean-Six Sigma MethodologiesEnrollment Process OptimizationData Analysis and KPI DefinitionCustomer Service Operations

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Operational Process ImprovementData AnalysisKPI DevelopmentClaims ProcessingMembership ManagementContinuous Improvement MethodologiesProcess StandardizationVendor ManagementRoot-Cause AnalysisFulfillment Operations

Soft Skills

Strategic Problem-SolvingCollaborationLeadershipCommunicationIssue Identification

Tools & Technologies

Facets Claims System

Industry Keywords

Health Plan OperationsMember AcquisitionCustomer RetentionQuality AssuranceOperational Excellence

About the role

Key responsibilities & impact

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

What you’ll need

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

Benefits

Comp & perks

Work-life balance, flexibility, and autonomy
Medical, dental, and vision coverage
Health and wellness programs
Parental leave and support
Adoption and surrogacy assistance
Career development programs
Tuition reimbursement for continued education
401k match including an annual company contribution
Paid Time Off (PTO)
Annual Incentive Bonus
Reasonable accommodations for applicants with disabilities