1 Insurance Operations Manager Job

**Remote work available for candidates outside Miami**

The Operations Excellence Lead drives operational performance, service excellence, and continuous improvement across ELAN's operational ecosystem, ensuring processes consistently deliver for members, providers, employer groups, brokers, and internal stakeholders, while maintaining compliance, efficiency, and quality.

This is a dual-mandate role. Externally, it owns measurable outcomes in customer experience, claim operations, and vendor performance. Internally, it closes the accountability gaps that currently exist across ELAN's operations: undocumented processes, contracts and initiatives without a peer reviewer of record, institutional knowledge concentrated in single individuals, and operating meetings that end in discussion rather than dated commitments. Working directly with the VP of Operations, this person becomes the standing owner of execution; the person who ensures every open item has a name and a date attached to it and stays that way.

Primary Responsibilities:

1. Customer Experience Leadership
• Champion a culture centered on exceptional customer service and operational excellence.
• Lead resolution of complex member, provider, client, and broker operational issues; serve as the primary operational escalation point for high-impact service concerns.
• Monitor complaints, grievances, appeals, and service trends to identify improvement opportunities.
• Develop and implement corrective action plans that improve satisfaction and eliminate recurring issues.
• Collaborate with Customer Service leadership on service quality, responsiveness, and first-contact resolution.

2. Claims Operations Excellence
• Own operational oversight of claims performance, inventory, turnaround time, and quality metrics, including the current claim lag and inventory backlog.
• Coordinate cross-functional teams to resolve complex claims processing issues.
• Lead root cause analysis for recurring claims errors and implements sustainable corrective actions.
• Identify workflow inefficiencies and recommend automation and process improvements.
• Ensure benefit configuration changes and operational enhancements are accurately implemented and validated.

3. Vendor Performance & Business Partnership
• Manage day-to-day relationships with operational vendors.
• Monitor vendor performance against contractual SLAs and KPIs; drive resolution of vendor-related issues affecting customer experience.
• Coordinate operational reviews and performance improvement initiatives with business partners.
• Own contract lifecycle tracking for operational agreements: peer review of record, effective dates, contract situs, dispute-resolution terms, and consequences of non-signature, closing the gap where contracts have moved without a named reviewer.
• Maintain an operating calendar for key vendor partners (QBRs, SLA reviews, remediation plans) and ensure follow-up actions are tracked and closed.
• Develop and maintain vendor scorecards (service-level metrics, claims timeliness, error rates) to support performance conversations with leadership and partners.

4. Operational Governance, Documentation & Risk
• Maintain a single, current tracker of all open operational items, issue, required outcome, action, owner, and date, and drive items to closure rather than letting them persist across reporting cycles.
• Coordinate the MOR and other cross-functional operating meetings so every agenda item closes with a named owner, action, and date on record.
• Identify and close single-point-of-failure risks where institutional knowledge or data sits with one individual outside approved system; drive migration to approved infrastructure.
• Document current-state and future-state workflows for critical processes that today rely on a single, unreviewed owner.
• Own triage and routing of escalated service and claims issues from clients, brokers, and internal teams, ensuring each has a documented owner, resolution path, and due date.
• Serve as primary operations point of contact for high-priority escalations; coordinate with vendors, internal claims teams, and client service to drive issues to closure and prevent recurrence.
• Escalate operational risks with practical recommendations, not just status updates.

5. Performance Management & Reporting
Develop and maintain operational dashboards covering:
• Customer and Provider Satisfaction
• Claims Turnaround Time, Accuracy, and Inventory Aging (30/60/90-day)
• Service Level Agreement Compliance and Vendor Performance
• Operational Backlog and Continuous Improvement Initiatives
• Provide leadership with regular, dated performance reviews, operational insights, trend analysis, and recommendations to support strategic decision-making.

**Remote work available for candidates outside Miami**