Senior Operations Analyst

We are seeking an experienced Operations Excellence Lead to drive operational performance, service excellence, and continuous improvement across a growing healthcare organization. This role is responsible for ensuring operational processes consistently deliver exceptional experiences for members, providers, employer groups, brokers, and internal stakeholders while maintaining efficiency, quality, and regulatory compliance. This is a highly visible position that partners directly with executive leadership to improve accountability, optimize operations, and ensure strategic initiatives move from planning to execution. The ideal candidate is organized, analytical, and thrives in a fast-paced environment where they can lead cross-functional initiatives and create lasting operational improvements. What You’ll Do Promote a culture focused on exceptional customer service and operational excellence. Lead the resolution of complex member, provider, client, and broker issues. Monitor complaints, appeals, grievances, and service trends to identify opportunities for improvement. Develop corrective action plans that improve satisfaction and eliminate recurring issues. Partner with Customer Service leadership to improve responsiveness and first-contact resolution. Oversee claims performance, inventory, turnaround times, quality metrics, and backlog management. Coordinate cross-functional teams to resolve complex claims processing issues. Conduct root cause analyses to identify recurring issues and implement sustainable solutions. Identify workflow improvements, automation opportunities, and operational efficiencies. Ensure benefit configuration changes and operational enhancements are accurately implemented and validated. Manage relationships with third-party administrators, operational vendors, and business partners. Monitor vendor performance against service level agreements (SLAs) and key performance indicators (KPIs). Lead operational reviews and performance improvement initiatives. Track operational contracts, key milestones, renewals, and compliance requirements. Maintain vendor scorecards to evaluate service quality, turnaround times, and operational performance. Maintain a centralized tracker for operational initiatives, action items, ownership, and deadlines. Ensure meetings conclude with documented action items, responsible owners, and completion dates. Identify operational risks, process gaps, and single points of failure while implementing sustainable solutions. Document and standardize workflows to improve consistency and knowledge sharing. Manage high-priority operational escalations from clients, brokers, and internal teams through resolution. Escalate operational risks with practical recommendations and actionable solutions. Develop and maintain operational dashboards and reporting for: Customer and provider satisfaction Claims turnaround times, accuracy, and aging Vendor performance and SLA compliance Operational backlogs and continuous improvement initiatives Provide leadership with regular operational reporting, trend analysis, performance insights, and strategic recommendations. Qualifications Bachelor's degree in Business Administration, Healthcare Administration, Operations Management, or a related field. 5+ years of progressive leadership experience in healthcare operations, managed care, health insurance, or another highly regulated service environment. Demonstrated success leading operational improvement initiatives and managing complex projects from planning through execution. Experience overseeing customer service, claims operations, or operational performance programs. Proven ability to influence cross-functional teams and drive accountability without direct reporting authority. Experience managing vendor relationships and operational contracts throughout their lifecycle. #J-18808-Ljbffr Segrera Associates