Operations Manager- Member Experience

As Operations Manager – Member Experience, you will play a key role in ensuring seamless, high-quality healthcare experiences by overseeing member issue resolution, operational quality, and continuous improvement initiatives. You will serve as a trusted partner to clients, consultants, vendors, and internal teams, managing complex escalations from initial reporting through final resolution. Your focus will extend beyond resolving individual cases to identifying root causes, implementing sustainable solutions, and preventing recurring issues. You will lead quality assurance efforts, monitor performance metrics, and help optimize AI-powered tools to improve service delivery and operational efficiency. Through coaching and collaboration, you will empower teams to deliver reliable, compliant, and member-first support. This remote opportunity offers the chance to make a meaningful impact on healthcare operations in a dynamic, technology-driven environment.

• Relevant Professional Experience: At least 3 years of experience in member experience, pharmacy benefit management (PBM), pharmacy claims, or related healthcare operations.

• People Management Experience: At least 2 years of experience managing teams in a queue-based or contact center environment, including responsibility for escalations, quality assurance, or operational performance.

• Client-Facing Communication: Demonstrated experience resolving member-facing issues directly with clients, consultants, or vendors, including explaining root causes, communicating outcomes, and managing expectations.

• Root Cause Analysis: Proven ability to investigate complex operational problems, identify underlying causes, and implement sustainable corrective actions supported by measurable results.

• Healthcare and Regulatory Knowledge: Working knowledge of prior authorization, coordination of benefits, pharmacy claim rejections, and HIPAA requirements.

• Technical Proficiency: Experience using CRM platforms or claims management systems, along with strong Microsoft Excel skills, including pivot tables.

• Education: High school diploma or equivalent required. A bachelor's degree in healthcare administration, business administration, or a related discipline is preferred.

• Additional Industry Experience: Experience in specialty pharmacy, mail-order pharmacy, or long-term care settings is an advantage. Experience presenting operational insights and improvement plans to clients or executive stakeholders is also preferred.

• Analytical and Problem-Solving Skills: Strong investigative mindset, attention to detail, and ability to use data to identify trends, assess risks, and distinguish symptoms from underlying causes.

• Communication and Relationship Management: Excellent written and verbal communication skills, with the ability to explain complex issues clearly, handle difficult conversations with composure, and build trust with diverse stakeholders.

• Leadership and Accountability: Strong coaching, team development, decision-making, and organizational skills, with a demonstrated commitment to following issues and corrective actions through to verified resolution.

• Adaptability and Operational Judgment: Ability to prioritize competing demands, make sound decisions under pressure, and take on evolving responsibilities in a growing healthcare organization.

• Work Environment and Availability: Comfortable working remotely with extended computer and phone use. Willingness to participate in on-call coverage for urgent escalations, accommodate occasional extended hours and partner calls outside standard business hours, and travel occasionally for meetings, training, or client and vendor visits.

• Work Authorization: Applicants must be legally authorized to work full-time in the United States without requiring employer sponsorship, visa transfer support, or other employer-provided immigration-related employment authorization, either now or in the future.