Operations Manager

Role Overview

The Operations Manager will lead day to day delivery for a healthcare BPO account,

managing a team of supervisors and frontline associates who handle clinical and non-

clinical processes for a global healthcare client.

The role is accountable for operational performance, client satisfaction, people

management, and compliance to all healthcare regulations and information security

requirements.

Key Responsibilities

1. Operational Management

 Own end to end delivery for assigned processes such as claims, prior

authorization, utilization review, case management, member or provider support,

or medical records.

 Achieve and sustain contractual SLAs and KPIs (AHT, productivity, quality, TAT,

CSAT/NPS, adherence, backlog, etc.).

 Track daily performance through dashboards and reports and drive action plans

with Team Leaders.

 Manage staffing, schedules, and skilling in partnership with WFM to ensure the

right capacity and coverage.

 Ensure timely resolution of escalations from clients and internal stakeholders.

1. People Leadership

 Lead, coach, and develop a team of Team Leaders / Supervisors and frontline

associates.

 Drive engagement, motivation, and a high performance culture through regular

1x1s, huddles, and team connects.

 Own attrition, absenteeism, and tenure improvement for the account and

implement retention plans.

 Identify skill gaps and partner with Training / Quality to run upskilling, cross

skilling, and refresher initiatives.

 Support fair and timely performance appraisals, rewards, and corrective actions

when required.

1. Client and Stakeholder Management

 Act as the primary operational contact for the client's operations leaders.

 Participate in regular governance calls, business reviews, and performance deep

dives.

 Translate client feedback into clear action plans with timelines and owners.

 Partner with internal stakeholders (HR, WFM, Training, Quality, IT, Compliance,

Finance) to support account needs.

1. Quality, Compliance, and Risk Management

 Ensure strict adherence to healthcare regulations and standards (e.g. HIPAA,

PHI handling, data privacy, information security).

 Drive a strong quality culture using audits, RCA, CAPA, and continuous

coaching.

 Ensure all staff complete mandatory compliance, information security, and

process trainings on time.

 Proactively identify operational risks and implement preventive controls and

mitigation plans.

1. Continuous Improvement and Transformation

 Use data to identify trends, gaps, and opportunities to improve quality, efficiency,

and customer experience.

 Lead process improvement projects using Lean or Six Sigma concepts.

 Support automation, analytics, and digital initiatives that enhance performance

and reduce cost to serve.

 Contribute ideas to scale the account, expand scope, and support new business

opportunities.

Qualifications

 Bachelor's degree in Nursing, Healthcare, Life Sciences, Business, or related

field required.

 Master's degree or healthcare certification (e.g. RN, USRN, CPC, CPHQ) is an

advantage.

Experience

 7+ years total experience in BPO / shared services, with at least 3+ years in a

people management role.

 Strong background in healthcare processes such as payer, provider, PBM,

utilization management, case management, or health insurance operations.

 Hands on experience managing a medium to large team (80+ FTE preferred)

through Team Leaders or Supervisors.

 Proven track record of meeting SLAs, improving KPIs, and managing client

relationships in a healthcare or insurance account.

Skills and Competencies

Technical and Domain

 Solid understanding of US healthcare ecosystem (payer, provider, plans,

benefits, authorizations, coding, claims, etc.).

 Strong grasp of metrics such as productivity, quality scores, AHT, FCR, TAT,

occupancy, and utilization.

 Comfort with Excel and reporting tools for data analysis and performance

management.

 Working knowledge of quality frameworks and basic Lean or Six Sigma concepts.

Leadership and Behavioral

 Strong people leadership, coaching, and conflict management skills.

 Excellent communication and presentation skills in English, written and verbal.

 Client facing and comfortable handling escalations and difficult conversations.

 High sense of ownership, urgency, and accountability.

 Ability to work in a fast paced, 24x7 global delivery environment.

Key Performance Indicators

 SLA and KPI achievement for the line of business.

 CSAT / NPS and client feedback scores.

 Attrition and absenteeism within defined thresholds.

 Quality scores and audit findings.

 Aging, backlog, and turnaround time.

 Compliance adherence and zero tolerance incidents.