Manager, Customer Success Operations

Key Responsibilities

• Lead Tier 2 Customer Success Operations, including complex case teams, Team Lead II oversight, backlog management, SLA performance, and escalated operational workflows.
• Establish and maintain operational standards for case ownership, customer updates, documentation, escalation quality, and cross-functional handoffs.
• Use data to identify repeat contacts, broken processes, system issues, policy gaps, and operational defects that drive customer dissatisfaction.
• Partner with Billing, Finance, Claims, Enrollment, Network, Product, Engineering, Clinical Operations, Sales, Compliance, Tier 1, and Tier 3 to resolve systemic issues.
• Develop and maintain Tier 2 SOPs, workflow documentation, case templates, escalation criteria, and quality standards.
• Drive process improvement initiatives designed to reduce complaint volume, improve first-touch routing, reduce rework, and strengthen customer trust.
• Manage, coach, and develop Tier 2 Team Leads and Specialists.
• Provide leadership reporting on backlog health, aging, SLA compliance, root cause themes, customer impact, and corrective actions.
• Ensure operations comply with HIPAA, privacy, CMS, ACA, state, and internal requirements.

Qualifications

• 5 or more years of healthcare, health insurance, customer operations, claims, billing, eligibility, enrollment, or service operations experience.
• 3 or more years of leadership experience in a contact center, health plan, shared services, claims, billing, enrollment, or customer operations environment.
• Strong understanding of claims, billing, eligibility, enrollment, provider access, member financial responsibility, and customer escalation workflows.
• Demonstrated experience managing SLAs, operational inventory, process improvement, and cross-functional work streams.
• Ability to analyze trends, build action plans, and communicate operational risks to senior leadership.

Preferred

• ACA marketplace or commercial health plan experience.
• Experience with Salesforce, Five9, claims systems, eligibility systems, payment systems, WFM platforms, QA tools, and dashboards.
• Bachelor's degree in healthcare administration, business, operations, analytics or a related field is preferred.