Senior Lead of Strategic OperationsPosition SummaryThe Senior Lead of Strategic Operations is responsible for overseeing the daily operational performance of the organization's customer service, referral and authorization, and claims processing departments. This leadership role ensures operational efficiency, compliance with service standards, timely processing of referrals, authorizations, and claims, and effective management of departmental staff.
The Senior Lead of Strategic Operations supervises approximately 10-15 employees, the majority of whom are union-represented employees, and is responsible for maintaining productive labor relations while ensuring compliance with company policies and collective bargaining agreements.
This is a remote position; however, occasional onsite attendance may be required for meetings, trainings, operational needs, or leadership initiatives.
Essential Duties and ResponsibilitiesOperational Leadership- Oversee the overall day-to-day operations of the care coordination and claims departments
- Develop and implement operational strategies to improve efficiency, service levels, and departmental performance
- Monitor departmental workflows to ensure operational goals and deadlines are consistently achieved
- Identify operational challenges and implement corrective action plans as needed
- Ensure compliance with company policies, HIPAA regulations, and applicable contractual requirements
Care Coordination & Call Center Oversight- Manage the Care Coordinator team within the call center environment
- Ensure appropriate staffing and scheduling to maintain operational coverage and service standards
- Monitor call center metrics and performance indicators, including:
- Average speed to answer (ASA)
- Call quality and productivity
- Ensure departmental performance standards are consistently met, including:
- Abandonment rate below 3%
- Average speed to answer below 30 seconds
- Provide training, coaching, performance management, and operational support to Care Coordinators and supervisory staff
Referral & Authorization Management- Oversee referral and authorization workflows and processing accuracy
- Ensure all referrals and authorizations are processed within 48 hours of receipt
- Monitor turnaround times and implement workflow improvements as necessary
- Resolve escalated referral and authorization concerns from providers, members, and staff
Claims Department Oversight- Manage claims department operations to ensure timely and accurate claims processing
- Ensure claims adjustments and corrections are completed promptly and accurately
- Monitor claims aging, processing timelines, and productivity metrics
- Collaborate with leadership and vendors regarding claims-related operational concerns
Leadership & Employee Management- Supervise, mentor, and support approximately 10-15 employees
- Conduct performance evaluations, coaching sessions, and disciplinary actions as appropriate
- Maintain effective working relationships within a union environment and ensure compliance with collective bargaining agreements
- Assist with recruitment, onboarding, and staff development initiatives
- Foster a positive, collaborative, and service-oriented work environment
Performance Expectations- Maintain call center performance standards, including:
- Average abandonment rate below 3%
- Average speed to answer below 30 seconds
- Ensure all referrals and authorizations are processed within 48 hours of receipt
- Ensure claims processing and adjustments are completed within established turnaround times
- Maintain high levels of accuracy, productivity, and customer satisfaction
- Support operational efficiency and continuous process improvement initiatives
Qualifications- Bachelor's degree in healthcare administration, business administration, operations management, or related field preferred
- Minimum of 3-5 years of healthcare operations or call center leadership experience required
- Experience managing claims, referrals, authorizations, or healthcare customer service operations preferred
- Prior supervisory or management experience required
- Experience working within a union environment strongly preferred
- Strong leadership, organizational, and problem-solving skills
- Excellent verbal and written communication abilities
- Strong analytical and operational management capabilities
- Ability to manage multiple priorities in a fast-paced environment
- Proficiency with Microsoft Office and operational software systems
Work Environment- Occasional onsite attendance may be required for meetings, trainings, operational reviews, or other business needs
- Must maintain a secure and professional remote work environment with reliable internet access
Physical Requirements- Prolonged periods of sitting and computer use
- Frequent communication via phone, video conference, and email
- Ability to work extended hours as operational demands require
