Manager, Operations Automation & Strategy

Availity

5d • Remote

About The Position

The Manager, Operations Automation & Strategy is responsible for leading teams that support health plan and provider service delivery through operational excellence, workflow optimization, automation, and systems monitoring. This role oversees the Missing Claim Response process, operational triage and escalation management, and known issue governance to ensure timely resolution of operational risks and service disruptions.
The Manager drives continuous improvement initiatives that enhance operational efficiency, strengthen monitoring capabilities, reduce manual effort, and improve scalability. Serving as a key liaison between Operations, Product, Engineering, Account Management, Client Success, and health plan stakeholders, this role promotes service stability, clear ownership, and data-driven decision making across critical operational workflows.

Requirements

• Bachelor’s degree
• Five or more years of experience in healthcare payer operations
• Three or more years of leadership experience managing operational, systems, analytical, or technical teams.
• Strong understanding of healthcare claims processing, payer operations,
• Demonstrated ability to identify process improvement and automation opportunities and translate operational needs into actionable requirements.
• Experience managing cross-functional relationships with Product, Engineering, Operations, Client Services, Account Management, and other stakeholders.
• Strong analytical, problem-solving, organizational, and decision-making skills.
• Excellent written and verbal communication skills, with the ability to communicate complex operational and technical information clearly.

Nice To Haves

• Experience managing configuration-driven solutions, transaction monitoring, or healthcare transaction workflows.
• Knowledge of EDI transactions, including the 837, 835, 277CA, and HIPAA X12 standards.
• Familiarity with Jira, ServiceNow, salesforce, dashboard development, workflow automation, reporting tools, and operational analytics.
• Experience defining requirements for automated workflows, alerts, monitoring solutions, and exception management.

Responsibilities

• Lead and develop a team of analysts and operational specialists.
• Establish performance goals, monitor operational metrics, and provide coaching and professional development.
• Foster a culture of accountability, collaboration, innovation, and continuous improvement.
• Ensure clear responsibilities, escalation paths, and service expectations across the team.
• Oversee the Missing Claim Response workflow, including monitoring, investigation, escalation, and resolution activities.
• Identify operational risks, recurring response gaps, processing trends, and payer-specific issues.
• Lead the intake, triage, prioritization, and routing of operational tickets, known issues, and support requests.
• Establish workflow standards and governance to improve efficiency and reduce delays, duplicate work, and unclear ownership.
• Ensure timely resolution of production issues, client escalations, and operational support requests.
• Lead the identification, tracking, communication, and resolution of known issues and operational risks.
• Identify, prioritize, and implement automation opportunities that improve efficiency, accuracy, and scalability.
• Partner with Product and Engineering teams to develop automated workflows, monitoring solutions, dashboards, and reporting capabilities.
• Evaluate operational processes to identify opportunities for standardization, simplification, and continuous improvement.
• Define business requirements, success metrics, and operational controls for automation initiatives.
• Measure and report on automation outcomes, including reductions in manual effort, processing time, and operational risk.
• Partner with internal stakeholders to translate operational challenges into scalable solutions and strategic initiatives.
• Communicate operational health, risks, trends, and improvement opportunities to leadership.
• Support operational planning, capacity management, and service delivery strategies.
• Provide recommendations related to operational priorities, process improvements, monitoring capabilities, and technology investments.

Benefits

• competitive salary
• bonus structure
• generous HSA company contribution
• healthcare
• vision
• dental benefits
• 401k match program
• unlimited PTO for salaried associates
• 9 paid holidays
• reimbursement up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• education reimbursement
• Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager