About This Role
We are seeking a highly experienced Senior Operations Manager to provide operational leadership and process oversight within the Special Investigations Unit (SIU). This interim role will focus on optimizing workflows, improving operational efficiency, strengthening cross-functional collaboration, and ensuring consistent execution of SIU processes. The ideal candidate will bring a combination of healthcare compliance, investigative operations, and business process expertise to support a high-performing and compliant SIU function.
What You Will Work On
Key Responsibilities - Provide operational leadership and oversight for SIU programs, processes, and day-to-day activities.
- Drive consistency, efficiency, and quality across investigative, audit, and compliance-related workflows.
- Assess current operational processes and identify opportunities for standardization, optimization, and continuous improvement.
- Develop and implement process enhancements that improve productivity, turnaround times, and overall team effectiveness.
- Serve as a resource for complex operational questions, escalations, and process-related challenges.
- Monitor performance metrics, operational trends, and key deliverables to support informed decision-making.
- Ensure adherence to regulatory requirements, internal policies, documentation standards, and compliance expectations.
- Partner with internal stakeholders across Compliance, Audit, Legal, Medical Management, and Operations to support program objectives.
- Create and maintain operational workflows, standard operating procedures (SOPs), and best practices.
- Provide regular updates, recommendations, and strategic insights to senior leadership regarding operational performance and improvement opportunities.
- Support change management initiatives and promote adoption of enhanced business processes.
What You Will Bring
Qualifications - Bachelor's degree required; advanced degree or certifications such as CFE, AHFI, CHC, or equivalent preferred.
- 7+ years of progressive leadership experience in healthcare compliance, SIU, fraud, waste and abuse (FWA), investigations, audit, or health plan operations.
- Demonstrated success leading operational improvement initiatives and implementing sustainable business processes.
- Strong understanding of managed care operations, healthcare regulations, CMS requirements, and FWA programs.
- Proven ability to evaluate workflows, identify gaps, and implement process improvements that drive measurable results.
- Excellent analytical, organizational, and problem-solving skills.
- Strong leadership, communication, and stakeholder management capabilities.
- Ability to quickly assess operational needs and provide effective leadership in a temporary or interim capacity.
What You Can Expect
- An inspirational place for you to do your best work, be engaged in meaningful ways, and continually develop the skills, competencies and qualities that set our team apart.
- Compensation commensurate with your qualifications, experience, and other factors including geographic location, market and operational factors.
- Total Rewards include: Medical, Dental, Vision, Life Insurance, Disability Insurance, 401(k) Savings Plan, Employee Stock Purchase Plan, Professional Development Program, Paid Time Off and Paid Sick Time (in geographies where legally required).
