Senior Manager, Operations

Blue Cross and Blue Shield of North Carolina • Durham, CA

2d • $130,560 - $208,896

About The Position

The Senior Manager, Operations role is pivotal in overseeing multiple functions which may include membership, enrollment, system support, customer service, claims, and fulfillment processes. This position ensures efficiency and productivity by delivering operational and analytics services across customer segments to improve performance. This role will contribute to a differentiated consumer experience by delivering timely, accurate fulfillment through innovative and integrated processes and channels. This position requires a thorough knowledge of all operational functions supporting a large ASO group including both dedicated and allocated resources.

Requirements

• Bachelor's degree or advanced degree (where required)
• 8+ years of experience in related field.
• In lieu of degree, 10+ years of experience in related field.

Nice To Haves

• Extensive experience in health plan claims, membership, and customer service operations with a strong understanding of end-to-end processes strongly preferred.
• Demonstrated analytical and strategic problem-solving skills with the ability to lead transformational, consumer-focused improvements while balancing operational excellence strongly preferred.
• Experience applying Six Sigma, Lean, or continuous improvement methodologies to optimize processes, enhance performance, and drive measurable results strongly preferred.
• Experience with Facets claims and membership processing systems preferred

Responsibilities

• Direct accountability for the successful operation of the Operations Center of Excellence, provide leadership for operational functions which may include membership, enrollment, system support, customer service, claims, and fulfillment processes ensuring alignment with organizational goals and objectives
• Oversee the enrollment process to ensure efficiency and accuracy while continuously seeking opportunities for process improvement
• Collaborate with cross-functional teams to develop integrated strategies for member acquisition and retention
• Establish and maintain quality assurance measures to ensure data accuracy, completeness, and integrity throughout the enrollment process
• Define key performance indicators (KPIs) and metrics to measure the effectiveness of membership and enrollment initiatives, analyzing data to inform decision-making and drive continuous improvement
• Manage relationships with enrollment system vendors and other partners, overseeing service delivery and vendor performance to ensure optimal outcomes for the organization and members
• Oversee Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
• Oversee fulfillment operations to meet all performance and production expectations
• Maintain strong connection to member experience and front-line challenges to drive member-centric culture of accuracy and timeliness that proactively exposes issues and pursues root causes
• Collaborate with business leads from Operations to enable end-to-end operations value chain aided by timely and accurate fulfillment
• Design, implement, and manage scalable functional processes that are flexible to resource deployment needs
• Identify and pursue opportunities for process standardization and automation to improve effectiveness, reduce errors and reduce costs
• Collaborate with Account Implementation, Configuration, and Service that leads to identify areas that drive member escalations
• Partner with Continuous Improvement and Vendor Services teams to identify improvement and sourcing opportunities, including process optimization through Lean-Six Sigma methodologies
• Collaborate with business partners across the Enterprise such as Sales, Digital Services to determine solutions and address concerns to meet corporate objectives and customer needs
• Partner with operational leads and workforce management to supplement strategy with the development of budgets, staffing models, and operational performance standards
• Approve business and technical requirements, oversee initiatives, and prioritize decisions to effectively address evolving business needs
• Resolve complex escalations and contribute to training development to maintain and improve service delivery
• End to end inventory management to align with all regulatory, Internal, external and other applicable processing guidelines and timeliness expectations; includes evaluating and adjusting all processing guidelines as required to meet customer expectations
• Report operational updates to the Claims AVP and Health Plan Operations VP; serve as a subject matter expert for ASO Group Operations

Benefits

• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution

What This Job Offers

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