Oversee day-to-day execution of all operational functions to manage, meet or exceed client expectations across all service lines.
Provide hands-on planning and guidance to functional teams to meet deliverable requirements, SLAs and maintain customer satisfaction.
Own Implementation Team delivery with focus on budget ownership, project planning, resource allocation, and delivery outcomes.
Maintain, manage and meet departmental budgets for implementation and operational teams; align revenue targets with forecasted COGS.
Optimize team structures and roles through offshoring, automation, and continuous process improvement.
Create and empower agile, accountable teams fostering a culture of innovation, ownership, and problem-solving.
Establish and maintain internal KPIs and SLAs that exceed client commitments leveraging real-time data.
Continuously evaluate and implement efficient workflows, integrating technology and automation to enhance claims processing, call center performance, and enrollment functions.
Lead outsourcing and offshoring strategy to create capacity, control costs, and scale operations.
Drive deployment of agentic automation across operations, delivery, and implementation to eliminate inefficiencies and accelerate time-to-value.
Ensure strict adherence to regulatory compliance and performance standards while delivering high-quality outcomes.
Provide timely, transparent updates and reporting to stakeholders to support decision-making.
Provide strategic insight and recommendations to the CEO and executive team on operational optimization, technology adoption, and fiscal accountability.
Develop, monitor, and manage department budgets and forecasts; manage vendor relationships and performance related to operations and implementation.
Collaborate cross-functionally to develop and implement operational, strategic, and technical enhancements that elevate service quality and customer experience.
Lead, manage and hold teams accountable for results; perform other executive-level initiatives as assigned.
Requirements
Bachelor’s degree in business administration, Program Management, or similar or related field.
Proven experience managing complex BPO operations for healthcare payers, including claims, configuration, utilization management, call center, and enrollment services.
Strong understanding of payer operations, industry regulations, and emerging technologies.
Demonstrated success in managing large operational budgets, aligning revenue to COGS forecasts, and delivering measurable cost savings.
Experience managing global/offshore teams and implementing outsourcing strategies to improve scalability and reduce costs.
Deep expertise in automation and digital transformation, including deployment of agentic or intelligent automation platforms.
Highly data-driven with ability to interpret operational metrics, performance reports, and financial forecasts to guide decisions.
Demonstrated leadership in team transformation and building high-performing, client-centric teams.
Strong interpersonal and communication skills; able to collaborate and present at all levels, including board and executive audiences.
Strategic thinker able to balance long-term planning and immediate execution in a fast-paced, high-change environment.
Self-motivated, results-driven, highly organized with strong problem-solving and decision-making abilities.
Legal authorization to work in the United States without sponsorship (application asks this question and is required).
As a remote employee, ability to provide high-speed internet, a quiet and private place to work, a desk, and a chair (application requirement).