Senior Operations Specialist

Overview

Drives operational excellence, performance optimization, and strategic execution across assigned business units. Provides leadership and oversight of operational initiatives, ensuring alignment with organizational goals, regulatory requirements, and member/provider experience objectives. Partners closely with executive and operational leaders to translate strategic priorities into actionable execution plans, establish measurable performance targets, and drive accountability across cross‑functional teams. Plays a critical leadership function in improving workflows, enhancing system capabilities, strengthening operational controls, and advancing continuous improvement efforts.

Requires a strong balance of analytical rigor, strategic thinking, operational execution, and relationship management, serving as a key operational leader and advisor within Health Plans.

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer‑matched retirement saving funds
• Personal and financial wellness programs
• Pre‑tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

• Leads monitoring, analysis, and reporting of key operational performance metrics (quality, financial performance, productivity, utilization, service levels, and member/provider experience).
• Establishes and maintains standardized dashboards, scorecards, and reporting frameworks to support data‑driven decision‑making.
• Identifies trends, root causes, and performance gaps; develop and oversee corrective action plans in partnership with department leaders.
• Drives operational accountability by facilitating performance reviews and ensuring follow‑through on improvement initiatives.
• Supports annual budget planning, resource forecasting, and productivity optimization efforts.
• Champions continuous improvement methodologies (Lean, Six Sigma, or similar approaches) to improve efficiency, quality, and cost performance.
• Evaluates operational structures and recommend process redesign or reallocation of resources as needed.
• Translates executive and organizational priorities into structured operational workplans with defined milestones, owners, and measurable outcomes.
• Leads and manages cross‑functional projects impacting health plan operations, system enhancements, or workflow redesign.
• Partners with Science & Technology and Health Plan teams to prioritize system enhancements, optimize system functionality, and ensure operational readiness.
• Ensures operational impacts are assessed prior to implementation of new programs, policies, or regulatory requirements.
• Monitors initiative progress, mitigate risks, and escalates issues to senior leadership as appropriate.
• Proactively identifies operational risks and implement mitigation strategies.
• Ensures compliance with regulatory, contractual, accreditation, and internal policy requirements.
• Leads operational readiness efforts for audits, regulatory reviews, and health plan reporting requirements.
• Partners with Compliance and Legal teams to ensure processes remain aligned with evolving regulatory landscapes.
• Develops documentation standards and internal controls to strengthen oversight and accountability.
• Serve as a central liaison across Operations, Finance, IT, Compliance, Clinical, and Health Plan leadership.
• Builds strong relationships across departments to ensure alignment, transparency, and effective collaboration.
• Facilitates structured cross‑functional meetings to address operational challenges and drive resolution.
• Influences without direct authority to drive timely decision‑making and action.
• Supports change management efforts to ensure adoption of new processes, systems, or performance expectations.
• Serves as a strategic thought partner to executive leadership.
• Prepares executive‑level briefings, board materials, and…