Director, Operational Quality – Governance

Zelis

Director of Operational Quality & Governance at Zelis managing quality processes across healthcare payments. Leading teams and driving operational excellence in quality assurance and compliance initiatives.

Posted 4/29/2026full-timeSt. Petersburg • Florida, Montana • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Oversee daily execution of call monitoring and quality scoring processes
Own quality scorecards and evaluation frameworks including compliance, customer experience, and service effectiveness criteria
Ensure consistency, fairness, and calibration across evaluators to minimize scoring variability
Establish governance for quality standards, scorecards, checklists, peer audit requirements, audit protocols, and performance thresholds ensuring formal documentation, version control, and periodic review
Partner with Operations leaders to drive targeted improvement plans based on quality outcomes
Maintain strict adherence to regulatory, contractual, and compliance requirements embedded within scoring models
Serve as business co-owner of AI-enabled quality capabilities
Define the post-MVP roadmap for scaling AI-driven quality monitoring, including human-in-the-loop governance
Partner with Technology and AI teams to refine scoring models, evaluation logic, and data feedback loops
Establish controls to ensure AI-driven scoring maintains compliance rigor and audit defensibility
Evaluate emerging capabilities (e.g., real-time guidance, next-best-action support) for potential impact on quality and partner with Operations leadership on strategy and roadmap
Drive value realization, adoption metrics, and operational impact measurement of AI-enabled quality tools
Analyze recurring scoring patterns to identify systemic process, platform, training, or design signals for improvement opportunity
Build structured escalation and improvement pathways that feed into broader process excellence initiatives
Lead targeted continuous improvement initiatives where quality data indicates systemic risk or opportunity
Develop dashboards and executive-ready reporting that translate quality metrics into operational insights and strategic decisions
Partner cross-functionally to drive durable process redesign
Lead, mentor, and develop a team of quality professionals and analysts
Foster a culture of accountability, objectivity, continuous improvement, and operational excellence
Define role clarity, performance expectations, and capability development pathways
Ensure appropriate resourcing models across onshore and offshore quality monitoring needs
Build scalable governance processes that support business growth without linear headcount expansion

Requirements

What you’ll need

Bachelor’s degree with 15+ years of relevant experience or Master’s degree with 10+ years
8+ years of progressive leadership experience managing multi-level teams in operations or quality environments
Expertise in contact center quality assurance and compliance-based scoring frameworks
Demonstrated experience building or governing independent audit or quality oversight functions
Strong background in continuous improvement methodologies (Lean Six Sigma Black Belt or Master Black Belt strongly preferred)
Experience translating operational data into enterprise-level improvement initiatives
Proven ability to influence cross-functional leaders and drive alignment without direct authority
Experience partnering with Technology teams on AI-enabled or automation-driven solutions
Proficiency using AI tools skillfully with an understanding of how to develop intelligent prompts and/or agents
Strong executive communication skills, with the ability to present insights clearly to senior leadership
Experience operating in regulated healthcare, payer, or financial environments strongly preferred.

Benefits

Comp & perks

Hybrid and remote friendly culture
Professional development opportunities
Equal employment opportunity employer

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

quality assurancecompliance-based scoring frameworkscontinuous improvement methodologiesLean Six Sigma Black BeltAI-enabled solutionsdata feedback loopsperformance thresholdsaudit protocolsevaluation logicdashboard development

Soft Skills

leadershipmentoringinfluencingcommunicationcollaborationaccountabilityobjectivitystrategic decision-makingteam developmentprocess redesign

Certifications

Lean Six Sigma Black BeltLean Six Sigma Master Black Belt