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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Senior Operations Manager (Healthcare Account)