Operations Manager - Healthcare BPO

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.

2. 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.

3. 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.

4. 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.

5. 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.