Senior Operations Manager (Healthcare Account)

Position Overview

The Senior Operations Manager (Healthcare) will be responsible for leading, developing, and managing multiple healthcare programs or large-scale lines of business (LOBs) within our Iloilo clinical BPO center. This role demands a strategic leader with deep expertise in US healthcare operations (e.g., Medical Billing, Utilization Management, Claims Processing, Member/Provider Services, or Clinical Care Management) and a proven track record of navigating strict compliance landscapes.

You will bridge the gap between strategic client goals and day-to-day operational execution, ensuring metric delivery (SLAs/KPIs), financial profitability, and robust talent development while fostering a culture of compliance and patient-centric care.

Key Responsibilities

Operational Excellence & Client Management

SLA/KPI Ownership: Drive the delivery of critical healthcare and performance metrics (e.g., First Contact Resolution, Average Handle Time, Quality Assurance scores, Turnaround Time for claims/prior auths, and abandonment rates).

Client Relationship: Act as the primary operational point of contact for US-based healthcare clients. Lead Weekly, Monthly, and Quarterly Business Reviews (WBR/MBR/QBR).

Capacity Planning: Collaborate with Workforce Management (WFM) to ensure accurate forecasting, scheduling, and staffing utilization tailored to healthcare seasonality.

Healthcare Compliance & Quality Assurance

• Regulatory Guardrails: Enforce strict adherence to HIPAA, HITECH, and other PHI (Protected Health Information) data privacy regulations within the Iloilo site.
• Audit Readiness: Oversee continuous audit readiness for clinical or operational workflows, ensuring zero-breach compliance.
• Quality Governance: Partner with the Healthcare QA team to identify process gaps, implement root-cause analyses, and execute Corrective and Preventive Action (CAPA) plans.

Financial & Strategic Management

P&L Accountability: Manage the program’s budget, optimizing gross margins, controlling operational expenses, and managing seat utilization.

Process Improvement: Champion Six Sigma or Lean initiatives to eliminate waste, improve clinical/administrative workflow efficiency, and drive automation where applicable.

People Leadership & Development

Talent Pipeline: Mentor and develop Operations Managers, Team Leaders, and Subject Matter Experts (SMEs).

Retention Strategies: Drive engagement initiatives to manage and mitigate attrition, a critical factor in the competitive Iloilo BPO ecosystem.

Key Performance Indicators (KPIs)

• Client Satisfaction: CSAT / Net Promoter Score (NPS) relative to healthcare delivery.
• Operational Metrics: Turnaround Time (TAT), Accuracy/Quality Scores, and Financial Gross Margin targets.
• Compliance: 100% passing rate on internal and external HIPAA/regulatory audits.
• People: Attrition rate within targeted thresholds and leadership succession readiness.

Qualifications & Requirements

• Experience: Minimum of 5–8 years of managerial experience in a BPO environment, with at least 3–5 years specifically dedicated to Healthcare Operations (Payer, Provider, or Pharmaceutical pathways).
• Education: Bachelor’s degree in any field. A degree in Nursing, Allied Health, or Healthcare Administration is a massive advantage.
• Compliance Knowledge: Deep, demonstrable understanding of HIPAA guidelines, US healthcare insurance concepts (Copay, Deductibles, Prior Authorization), and ICD-10/CPT coding structures if managing coding lines.
• Leadership Scale: Proven experience managing a headcount of at least 150–300+ FTEs through subordinate managers.
• Location: Must be willing to work on-site in Iloilo City (Mandurriao/Megaworld, Pavia, or IT Complex hubs) primarily on US night shifts (Graveyard).

Preferred Certifications (Highly Regarded)

• US Registered Nurse (USRN) or Philippine Registered Nurse (RN) license.
• Six Sigma Green Belt or Black Belt certification.
• Certified Professional Coder (CPC) or Certified Professional Utilization Reviewer (CPUR), if applicable to specific LOBs.
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