Senior Operations Specialist

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Leads monitoring, analysis, and reporting of key operational performance metrics (quality, financial performance, productivity, utilization, service levels, and member/provider experience).
• Establishes and maintains standardized dashboards, scorecards, and reporting frameworks to support data-driven decision-making.
• Identifies trends, root causes, and performance gaps; develop and oversee corrective action plans in partnership with department leaders.
• Drives operational accountability by facilitating performance reviews and ensuring follow-through on improvement initiatives.
• Supports annual budget planning, resource forecasting, and productivity optimization efforts.
• Champions continuous improvement methodologies (Lean, Six Sigma, or similar approaches) to improve efficiency, quality, and cost performance.
• Evaluates operational structures and recommend process redesign or reallocation of resources as needed.
• Translates executive and organizational priorities into structured operational workplans with defined milestones, owners, and measurable outcomes.
• Leads and manages cross-functional projects impacting health plan operations, system enhancements, or workflow redesign.
• Partners with Science & Technology and Health Plan teams to prioritize system enhancements, optimize system functionality, and ensure operational readiness.
• Ensures operational impacts are assessed prior to implementation of new programs, policies, or regulatory requirements.
• Monitors initiative progress, mitigate risks, and escalate issues to senior leadership as appropriate.
• Proactively identifies operational risks and implement mitigation strategies.
• Ensures compliance with regulatory, contractual, accreditation, and internal policy requirements.
• Leads operational readiness efforts for audits, regulatory reviews, and health plan reporting requirements.
• Partners with Compliance and Legal teams to ensure processes remain aligned with evolving regulatory landscapes.
• Develops documentation standards and internal controls to strengthen oversight and accountability.
• Serve as a central liaison across Operations, Finance, IT, Compliance, Clinical, and Health Plan leadership.
• Builds strong relationships across departments to ensure alignment, transparency, and effective collaboration.
• Facilitates structured cross-functional meetings to address operational challenges and drive resolution.
• Influences without direct authority to drive timely decision-making and action.
• Supports change management efforts to ensure adoption of new processes, systems, or performance expectations.
• Serves as a strategic thought partner to executive leadership.
• Prepares executive-level briefings, board materials, and operational performance updates.
• Synthesizes complex data into clear, actionable insights and recommendations.
• Facilitates leadership forums, operational reviews, and strategic working sessions.
• Provides informed recommendations to support strategic planning and operational decision-making.
• Provides direct supervision, coaching, and development of assigned staff.
• Establishes clear performance expectations and conduct regular performance reviews.
• Supports implementation team leads in maintaining foundational materials for leadership forums.
• Ensures materials are prepared and distributed timely with value-driven, decision-oriented content.
• Partners with Implementation Team leads in executing portfolio oversight work, including but not limited to ROI oversight, tech change management, roadmaps, etc.
• Assists in governance cadence management and cross-functional alignment across strategic initiatives.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• Program or project management certification (PMP, Lean, Six Sigma) preferred

Education:

• Bachelor's Degree in Business Administration or related field, or equivalent work experience required

Work Experience:

• Minimum five years experience in business/managed care setting, including three years in Medicare and Medicaid required

• Supervisory experience required

• Demonstrated experience leading operational improvement initiatives and managing cross-functional projects required

• Proven success driving measurable performance improvement in quality, financial, or service metrics required

• Strong knowledge of healthcare delivery systems, managed care, regulatory requirements, and healthcare technology required

• Experience working with data analytics, reporting tools, and performance dashboards required

• Demonstrated ability to influence and collaborate with senior leaders and cross-functional stakeholders required

• Strong networking, business acumen, and relationship-building skills that translate into organizational impact required

• Excellent analytical, written, verbal, and interpersonal communication skills required

• Experience with health plan operations, claims, utilization management, quality programs, or value-based care preferred