Director, Call Center Operations

Harbor Health-posted 6 days ago

Full-time • Director

101-250 employees

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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.

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

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

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

Competitive salary and benefits package
Professional development and growth opportunities

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