Operations Director jobs in Fresno, CA

Summary/Objective:

The Director of Operations is responsible for leading and optimizing the operational performance of the organization, focusing on claims management, customer service, plan configuration, and quality assurance. This role involves strategic oversight, process enhancement, and team management to ensure the delivery of high-quality services to clients and plan participants.

Responsibilities:

Operations:

· Lead and manage the day-to-day operations of the TPA, including claims processing, customer service calls, plan configuration, and quality control.

· Develop and implement operational strategies to enhance efficiency, accuracy, and customer satisfaction.

· Oversee the design and implementation of systems, processes, and workflows to streamline operations and minimize errors.

· Collaborate with cross-functional teams, including IT, Finance, Client Services, to ensure seamless integration and compliance with regulatory requirements.

· Monitor key performance indicators (KPIs) and metrics to evaluate operational performance and identify areas for improvement.

· Establish and maintain quality assurance protocols and standards to uphold service excellence and exceed client expectations.

· Provide leadership, guidance, and mentorship to operations teams, fostering a culture of accountability, collaboration, and continuous improvement.

· Act as a primary point of contact for clients, addressing inquiries, resolving issues, and building strong relationships to drive client satisfaction and retention.

Network Management:

· Maintain current knowledge of claims network status and criteria

· Monitor and implement all necessary changes to processes, workflows etc., as mandated by the network, including all communication and branding requirements, file formats

· Track and maintain accountability for the network in partnership requirements and TAT pricing and operational functions needed to ensure the mutual success of claims administration

· Partner for any necessary escalated client UR and CM needs or concerns

· Review weekly dashboards for specific data sets

Business Functions:

· Set priorities with the overall understanding of member, employee, and organizational impact

· Identifies / implements processes or improvements to increase efficiency and service levels and close service gaps

· Supports organizational technology changes

· Ensures quality of work performed by direct reports in area(s) of responsibility

· Commits to a focus on continuous improvement of workflow processes and procedures

Qualifications:

1. Bachelor's degree in Business Administration, Operations Management, or related field or equivalent work experience.

2. Proven track record of successful leadership in healthcare operations management, specifically within the TPA industry.

3. Strong understanding of claims processing, customer service best practices, and quality assurance principles.

4. Strategic thinker with the ability to analyze data, identify trends, and develop actionable insights to drive operational excellence

5. In-depth knowledge of operational best practices, regulatory compliance requirements, and industry trends.

6. Strong analytical and problem-solving skills, with the ability to analyze complex data, identify patterns, and develop actionable insights.

7. Results-oriented mindset with a focus on delivering superior service and value to clients

8. Excellent communication and interpersonal skills, with the ability to effectively collaborate with cross-functional teams, executives, and external stakeholders.

9. Demonstrated experience in driving process improvement initiatives, managing change, and achieving measurable results.

10. Leadership qualities, including strategic vision, decision-making ability, and the capacity to inspire and motivate teams to achieve excellence.

11. Proficiency in project management methodologies and tools, with the ability to prioritize tasks, manage multiple projects simultaneously, and meet deadlines.

Job Type: Full-time

Pay: $89,500.00 - $115,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• TPA Operations: 1 year (Required)
• Leadership: 2 years (Required)

Work Location: In person