Job Description

A bit about this role: 

Our Payment Integrity Department ensures that provider claims are paid correctly by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices. As part of this function, the Business Operations Senior Manager is responsible for ensuring the success of Payment Integrity (PI)’s programs and processes.  

The ideal candidate is a self-starter who enjoys taking accountability for operational performance, solving complex operational problems and driving impact in close collaboration with cross-functional stakeholders and teams.

Your Responsibilities and Impact will include:

• Operational Orchestration: Own the daily health of the operation—monitoring TAT (Turnaround Time), clearing backlogs, and ensuring queue health remains optimal.
• SLA & Quality Governance: Oversee operational performance and maintain the feedback loop between high productivity and rigorous audit accuracy.
• Program Design and Launch: own the end-to-end design, testing, and launch of scalable cross-functional workflows, including change management, training, and post-launch KPI tracking.
• Cross-Functional Partnership & Alignment: Partner closely with external vendors and cross-functional stakeholders across Engineering, Network/Provider Operations, Claims, and Integrations to align on ongoing operational priorities, streamline end-to-end workflows, and drive shared business outcomes.
• Efficiency & AI Integration: Identify opportunities to lean out manual processes by deploying and managing AI agents alongside human staff.
• Friction Removal: Act as the primary escalation point to resolve blockers for vendors and internal teams, ensuring they have the training and job aids needed to succeed.

Required skills and experience:

• 6+ years of experience in business operations or operational leadership
• Demonstrated success in driving meaningful change and measurable operational results in fast-paced environments, with a bias toward action and a focus on continuous improvement.
• Thrives in operational execution, escalation management, and problem-solving
• Comfort with ambiguity, including unanticipated and sometimes messy issues that require ownership from triage to resolution
• Analytic mindset and ability to execute qualitative and quantitative analyses that drive impact
• Exceptional communication and cross-functional collaboration skills, with an ability to influence others
• Strong organizational skills, including prioritizing and managing multiple initiatives at once
• High degree of professionalism

Desired skills and experience:

• Curiosity and hands-on experience with AI tools, automation, or LLM-based workflows in operational settings is highly desired.
• 2+ years in a health tech, digital health, or healthcare technology environment (Medicare Advantage health plan and/or startup a plus)

• Experience influencing and driving change in a highly-matrixed organization

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Salary range: $110,500 - $150,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium

• Generous paid time off

• $100 monthly mobile or internet stipend

• Stock options for all employees

• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

• Parental leave program

• 401K program

• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.