Lead Healthcare Operations Analyst

About the Role

As a Lead Healthcare Operations Analyst, you will monitor customer service, claims, enrollment, and supporting functions to identify gaps, inconsistencies, emerging trends, and areas requiring adjustment. You will conduct frequent call listening and targeted reviews to identify issues, establish practical processes, and support training activities. Additionally, you will implement monitoring and quality controls, partner with the Project Manager, and recommend sustainable improvements.

Responsibilities

• Monitor customer service, claims, enrollment, and supporting functions to identify gaps, inconsistencies, emerging trends, and areas requiring adjustment.
• Conduct frequent call listening and targeted transcript, claims, and enrollment reviews to identify misinformation, process breakdowns, training needs, and service risks.
• Establish practical intake, triage, ownership, escalation, and closure processes.
• Resolve routine questions directly and elevate issues requiring leadership attention.
• Support initial training and role-based readiness activities.
• Implement monitoring and quality controls, verify corrective actions, and confirm changes are working as intended.
• Partner with the Project Manager to maintain an integrated issue and action tracker.
• Connect issues across functions, reinforce effective practices, and recommend sustainable process, training, communication, or control improvements.
• Document question intake, triage, escalation, and resolution processes.
• Provide regular findings from operational reviews and concise executive-level status updates.

Qualifications

• 7+ years of experience in self-funded medical insurance operations, implementation readiness, quality assurance, issue management, or a related role in a complex service environment.
• Strong knowledge of customer service operations and interdependencies among service, claims, enrollment, training, and implementation teams.
• Experience identifying operational risk through call monitoring, transcript analysis, data review, claims review, or similar quality activities.
• Strong judgment, organization, follow-through, and ability to translate complex issues into clear guidance and executive-level reporting.

Preferred Qualifications

• Health plan administration, benefits administration, claims operations, or similarly regulated experience.

Pay

Pay Range: $43 - $48 per hour. The pay range offered to a successful candidate will be based on several factors, including education, work experience, location, specific job duties, certifications, etc.

Benefits

• Medical & pharmacy coverage
• Dental/vision insurance
• 401(k)
• Health Savings Account (HSA) and Flexible Spending Account (FSA)
• Life Insurance
• Pet Insurance
• Short-term and Long-term Disability
• Accident & Critical Illness coverage
• Pre-paid legal & ID theft protection
• Sick time and other types of paid leaves (as required by law)
• Employee Assistance Program (EAP)

Position Type: Contract
Duration: 06 Months
Location: Philadelphia, PA

This position is only open to applicants who can be engaged on a W-2 basis. 1099 contractors and Corp-to-Corp arrangements will not be considered.