Director, Call Center Operations

Harbor Health

5d

About The Position

The Director, Call Center Operations ensures operational excellence, regulatory compliance, and member/provider satisfaction across Harbor Health's integrated payvider model. This role oversees call center operations for both health plan and clinical functions, managing SLA achievement, TPA partnerships, budgets, and quality assurance while ensuring compliance with TDI, CMS, and government regulations.

Requirements

• Bachelor's degree or 8+ years healthcare operations experience
• 6+ years managing payer health plan call centers covering claims, member services, appeals, and provider support
• Deep understanding of benefits, prior authorizations, claims processing, and appeals workflows
• Knowledge of call center functionality including IVR setup and queue management
• Experience developing operational SOPs and business requirement documents
• Proven ability to coach teams and manage multiple priorities independently
• Strong written and verbal communication skills

Nice To Haves

• Familiarity with TDI and CMS rules and regulations
• Startup phase health plan experience
• Background building call center teams from the ground up
• Advanced Excel and PowerPoint skills
• High integrity with commitment to confidentiality and compliance standards

Responsibilities

• Oversee call center operations for member services, claims, prior authorizations, appeals, and provider support
• Achieve monthly SLAs and implement corrective action plans for performance gaps
• Manage telephony systems, IVR routing, call queues, and optimize call center software functionality
• Hire, develop, and coach team members for performance excellence and career growth
• Ensure compliance with TDI, CMS, and government regulations; manage risks per compliance policies
• Create and maintain process flows, SOPs, and job aids for operational consistency
• Collaborate with vendors on system configurations and integrations
• Manage escalated calls and establish seamless handoffs with supporting teams
• Partner with business leaders to design metrics and dashboards with high analytical rigor
• Identify opportunities to improve efficiency, reduce costs, and enhance member/provider experiences
• Manage operational budgets and resource allocation

Benefits

• Competitive salary and benefits package
• Professional development and growth opportunities
• Transparent and unique startup culture

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Number of Employees: 101-250 employees