Responsible for strategic and tactical execution and management of claims, contact center and various other operations
Manage Operations team(s), including supervision of managers and supervisors
Oversee financial outcomes, including claims loading, adjudication, and payments
Manage all aspects of operations and ensure efficiency; develop and implement strategic plans aligned with company objectives
Meet financial and performance goals, including budget preparation
Provide vision for call center goals and lead a multi-site team; foster a collaborative, employee-focused environment; provide ongoing formal training
Conduct data analysis and present insights; establish and monitor key performance indicators (KPIs); implement best practices and drive process improvements for scalability and efficiency
Manage cross-functional projects; collaborate with clinical, IT, and other departments; own pharmacy and vendor relationships for claims processing, call routing, reporting, and communication
Vendor and client-facing responsibilities as needed; support corporate initiatives
Oversee call center operations, ensuring service quality and adherence to metrics; implement strategies for customer loyalty and consistency in messaging
Requirements
5+ years of experience successfully managing complex operations
5+ years in healthcare-related operations roles
Preferred knowledge of Pharmacy Benefit Management (PBM) operations and industry
Strong strategic thinking and problem-solving abilities
Ability to prioritize work for cross-functional teams
Excellent people leadership skills with servant leadership attributes
Proficiency in Microsoft Office, email, and internet tools
Experience in Call Center Software Management
Expertise in Operations Team Management
Strong verbal and written communication, presentation, and negotiation skills
Ability to engage with stakeholders effectively
Willingness to travel as needed to meet goals
Bachelor's degree in business, accounting, or related areas preferred