Operations Manager - Member Experience

📋 Description

• Act as a primary point of contact for member-related issues, ensuring clear communication
• Prioritize cases according to urgency and member impact, especially when medication access is at
• Investigate complaints, escalations, incidents, and quality failures using structured methodologies
• Lead quality monitoring activities including call and case audits, scorecard development, evaluator
• Act as subject matter expert for AI-powered tools; review AI-assisted interactions for accuracy and
• Coach and develop team leads and staff; oversee scheduling and performance objectives; conduct

🎯 Requirements

• At least 3 years of experience in member experience, pharmacy benefit management (PBM), pharmacy
• At least 2 years of experience managing teams in a queue-based or contact center environment
• Demonstrated experience resolving member-facing issues directly with clients, consultants, or
• Proven ability to investigate complex operational problems, identify root causes, and implement
• Working knowledge of prior authorization, coordination of benefits, pharmacy claim rejections, and
• Experience using CRM platforms or claims management systems, along with strong Microsoft Excel

🎁 Benefits

• Annual base salary of $75,000–$85,000 depending on qualifications and experience.
• Eligibility for a bonus in addition to base compensation.
• Access to health benefits.
• 401(k) plan with employer match.
• Stock options.
• Paid time off (PTO).