Operations Manager, Member Experience
New
J
JobgetherHealthcare operations
Remote work arrangement within the United StatesFull-TimeManager
SalaryAnnual base salary of $75,000–$85,000, depending on qualifications and experience. Eligibility for a bonus in addition to base compensation. Stock options.
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Job Details
- Experience
- At least 3 years of experience in member experience, pharmacy benefit management (PBM), pharmacy claims, or related healthcare operations; at least 2 years of experience managing teams in a queue-based or contact center environment.
- Required Skills
- Microsoft ExcelHIPAA
Requirements
- At least 3 years of experience in member experience, pharmacy benefit management (PBM), pharmacy claims, or related healthcare operations.
- At least 2 years of experience managing teams in a queue-based or contact center environment, including responsibility for escalations, quality assurance, or operational performance.
- Experience resolving member-facing issues directly with clients, consultants, or vendors, including explaining root causes, communicating outcomes, and managing expectations.
- Ability to investigate complex operational problems, identify underlying causes, and implement sustainable corrective actions supported by measurable results.
- Working knowledge of prior authorization, coordination of benefits, pharmacy claim rejections, and HIPAA requirements.
- Experience using CRM platforms or claims management systems, and strong Microsoft Excel skills, including pivot tables.
- High school diploma or equivalent required; a bachelor's degree in healthcare administration, business administration, or a related discipline is preferred.
- Specialty pharmacy, mail-order pharmacy, or long-term care experience is an advantage.
- Experience presenting operational insights and improvement plans to clients or executive stakeholders is preferred.
- Ability to prioritize competing demands, make sound decisions under pressure, and participate in on-call coverage for urgent escalations, occasional extended hours, and occasional travel.
Responsibilities
- Act as a primary point of contact for member-related issues and provide clear communication, proactive updates, and timely resolution.
- Prioritize cases by urgency and member impact, serve as the final internal escalation point for complex cases, and coordinate resolution with internal teams and external partners.
- Investigate complaints, escalations, incidents, and quality failures using structured root cause analysis methods, and oversee corrective and preventive action plans.
- Lead quality monitoring, including call and case audits, scorecard development, evaluator calibration, and performance feedback.
- Review AI-assisted interactions for accuracy, quality, and compliance, guide employees in using AI-powered tools, and identify automation opportunities.
- Coach and develop team leads and staff, oversee scheduling and performance objectives, and conduct performance reviews.
- Monitor and report operational KPIs, track corrective actions, identify emerging risks, and collaborate across functions to improve Member Experience operations.
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