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.

Sponsorship, in any form, is not available for this position.

Location: Remote, US

Qualifications:

Required

• 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.

Preferred

• 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.

Key Responsibilities:

Leadership & Team Management

• 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.

Operations & Issue Management

• 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.
• Automation & Process Improvement
• 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.
• Strategy & Cross-Functional Collaboration
• 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.

Availity culture and benefits:

• Availity is a certified “Great Place to Work”, a “Best Workplaces for Technology Companies”, a “Best Workplaces for Women” and a “Best Workplaces for Millennials”!
• Culture is important to us and there are many ways for you to make your mark here!
• We have several Diversity & Inclusion teams and various ways to engage with fellow Availity associates. “AvaiLadies”, “Beyond Black”, “HOLA”, “Availity Pride”, “VetAvaility” a Young Professionals Group and “She Can Code IT” a group for women in tech are some of the groups you can get involved in.
• Availity is a culture of continuous learning. We have many resources and experts in our tech stack and in our industry that can help get you there too!
• We offer a competitive salary, bonus structure, generous HSA company contribution, healthcare, vision, dental benefits and a 401k match program that you can take advantage of on day one!
• We offer unlimited PTO for salaried associates + 9 paid holidays. Hourly associates start at 19 days of PTO and go up from there with all the same holiday benefits.
• Interested in wellness? We allow our associates to reimburse up to $250/year for gym memberships, participation in racing events, weight management programs, etc.
• Interested in furthering your education? We offer education reimbursement!
• Availity offers Paid Parental Leave for both moms and dads, both birth parents and adoptive parents.
• Want to work for an organization that gives back to the community? You’re at the right place! Availity partners with various organizations, both locally and nationally, to raise awareness, funds and morale as our staff members volunteer their time and funds to engage the organizations campaign.

Next steps:

After you apply, you will receive text/email messages thanking you for applying and then you will continue to receive more text/email messages alerting you as to where you are in the recruitment process.

Interview process: 

• Recruiter resume review
• Managers resume review
• Recruiter screen
• Manager video interview
  

Video Camera Usage:

Availity fosters a collaborative and open culture where communication and engagement are central to our success.  As a remote first company, we are also camera-first and provide all associates with camera/video capability to simulate the office environment. If you are not able to use your camera for all virtual meetings, you should not apply for this role.

Having cameras on helps create a more connected, interactive, and productive environment, allowing teams to communicate more effectively and build stronger working relationships.  The usage of cameras also enhances security and protects sensitive company information. Video participation is required to ensure that only authorized personnel are present in meetings and to prevent unauthorized access, data breaches, preventing social engineering, or the sharing of confidential information with non-participants.