Operations Manager II

CareFirst BlueCross BlueShield   •  

Washington, DC

8 - 10 years

Posted 238 days ago

This job is no longer available.


Under the general supervision of the Director, the Manager’s accountabilities include, but are not limited to, the following:

1. Manages and leads daily activities of a large Operations area of business.  Maintains a high level of member, provider, and account satisfaction and retention by leading associates responsible for handling inquiries or processing claims or enrolling accounts for members, providers, group administrators, brokers, attorneys, insurance commissioners, and inquiries addressed to Senior Executive Staff and Medical Directors.  Responsible for all aspects of the section’s operation, including service to accounts, members, providers, claims adjustment and clerical workflows. Ensures that staff receive training, guidance, direction, support, and development, in order to obtain targeted results.  Ensures that a consistent, high quality, timely and cost effective level of service is provided, and that all internal and external (i.e. NMIS, NCQA performance standards) goals and objectives are met.

2. Coordinates cross-functionally with a wide range of areas to meet customer needs, implement projects, addresses service/processing issues, improves quality of service, and implements useful and improved technology.  Represents the Operational area on a wide range of corporate initiatives. Coordinates and develops policies, as well as the relationships, between the areas managed and otherdepartments of the corporation (such as Sales, Medical Affairs, Systems Analysis and Planning, Network Management, Contract Compliance, Legal, etc.) in order to:

  • facilitate the exchange of information,
  • provide competitive analysis and product planning,
  • aid strategic initiatives,
  • ensure customer and provider service issues are taken into consideration
  • ensure intradepartmental initiatives are effectively coordinated and implemented
  • achieve results

Ensures compliance of the areas managed with all regulatory requirements, mandates, policies and other requirements.  Provides substantial day-to-day support for internal areas.

3. Maintains regular contact with and is accountable for group administrators’/large accounts’/key providers’ satisfaction.  Responsible for the resolution of highly complex and sensitive account/member/provider issues.  Maintains direct customer and provider contact; personally handles the most complex and difficult inquiries and situations.  Prepares and delivers formal presentations, conducts account visits, interacts on a face-to-face basis with current and prospective accounts.

4. Reviews and analyzes data, reports, survey results, complaints, appeals data and performance information to strategically determine allocation of staff and to consistently meet or exceed performance expectations.  Develops strategies and executes detailed action plans to ensure excellent results and continuous improvement of service operation.

5. Responsible for associate development including Supervisor skills building.  Creates, approves and discusses all performance plans and reviews for associates.  Ensures adequate training, associate development and support.  Identifies performance issues and develops plans to improve that performance.  Uses action plans and career path tools where applicable.  Ensures staff adhere to all policies, procedures and processes.  Responsible for a positive and productive work environment and provides ongoing reinforcement and identification and resolution of problems.  Hires and terminates employment; handles corrective action.  Meets with staff at least bi-weekly.

6. Prepares and manages section’s budget and allocation of resources.

Direct reports include, but are not limited to: Supervisors, Customer Service Representatives or Claims Processors or Enrollment and Billing Technicians or Account Installation Technicians and/or Clerical staff.  Provides oversight of approximately 50+ indirect reports and 5+ direct reports.


Required: Bachelors Degree or equivalent work experience.  At least eight years of progressive management or supervisory experience in a customer service, claims or enrollment and billing related discipline.  Health Insurance and Call Center Experience, including knowledge of state of the art technology. 

Abilities/Skills: Proven ability to manage a large section and multiple responsibilities. Exceptional oral and written communication skills. Customer-focused and results-oriented.  Strong analytical/problem-solving abilities.  Extremely well-organized.  Demonstrated ability to achieve results under pressure.  Strong interpersonal and team building skills.  Innovative, flexible leader.

Preferred:  Bachelors Degree in Health Care Administration or Business Administration Preferred.


Department: Enrollment Business Support

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Job ID: 10852-1A