Note: The job is a remote job and is open to candidates in USA. PrimeCare Benefits Group, Inc. is seeking a Senior Lead of Strategic Operations to oversee daily operations across customer service, care coordination, referrals and authorizations, and claims processing. The role leads departmental staff, maintains service and compliance standards, and drives operational efficiency and performance.

Responsibilities

• Oversee the overall day-to-day operations of the care coordination and claims departments
• Develop and implement operational strategies to improve efficiency, service levels, and departmental performance
• Monitor departmental workflows to ensure operational goals and deadlines are consistently achieved
• Identify operational challenges and implement corrective action plans as needed
• Ensure compliance with company policies, HIPAA regulations, and applicable contractual requirements
• Manage the Care Coordinator team within the call center environment
• Ensure appropriate staffing and scheduling to maintain operational coverage and service standards
• Monitor call center metrics and performance indicators, including:
• Abandonment rate
• Average speed to answer (ASA)
• Call quality and productivity
• Ensure departmental performance standards are consistently met, including:
• Abandonment rate below 3%
• Average speed to answer below 30 seconds
• Provide training, coaching, performance management, and operational support to Care Coordinators and supervisory staff
• Oversee referral and authorization workflows and processing accuracy
• Ensure all referrals and authorizations are processed within 48 hours of receipt
• Monitor turnaround times and implement workflow improvements as necessary
• Resolve escalated referral and authorization concerns from providers, members, and staff
• Manage claims department operations to ensure timely and accurate claims processing
• Ensure claims adjustments and corrections are completed promptly and accurately
• Monitor claims aging, processing timelines, and productivity metrics
• Collaborate with leadership and vendors regarding claims-related operational concerns
• Supervise, mentor, and support approximately 10–15 employees
• Conduct performance evaluations, coaching sessions, and disciplinary actions as appropriate
• Maintain effective working relationships within a union environment and ensure compliance with collective bargaining agreements
• Assist with recruitment, onboarding, and staff development initiatives
• Foster a positive, collaborative, and service-oriented work environment

Skills

• Minimum of 3–5 years of healthcare operations or call center leadership experience required
• Prior supervisory or management experience required
• Strong leadership, organizational, and problem-solving skills
• Excellent verbal and written communication abilities
• Strong analytical and operational management capabilities
• Ability to manage multiple priorities in a fast-paced environment
• Proficiency with Microsoft Office and operational software systems
• Bachelor's degree in healthcare administration, business administration, operations management, or related field preferred
• Experience managing claims, referrals, authorizations, or healthcare customer service operations preferred
• Experience working within a union environment strongly preferred

Benefits

• This is a remote position; however, occasional onsite attendance may be required for meetings, trainings, operational needs, or leadership initiatives.

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