Senior Manager, Operational Excellence

🕒 Outubro 24

🎸 Tennessee – Remoto

🎸 Tennessee – Remote

💵 $100.000 - $110.000 / ano

⏰ Tempo Integral

🟠 Sênior

⚙️ Operações

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Intellivo

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 1999

🏥 Saúde

🛡️ Seguros

☁️ SaaS

Healthcare • Insurance • SaaS

A Intellivo é a Recovery Intelligence Platform para planos de saúde, TPAs e pagadores. A plataforma utiliza um ecossistema de dados proprietário e um “Recovery Intelligence Engine” para detectar oportunidades ocultas de subrogation e reimbursement que vão além do que os programas tradicionais de post-pay recovery conseguem identificar, viabilizando a recuperação de sinistros pagos sem questionários ou contato com os beneficiários. A Intellivo oferece um modelo end-to-end, sem risco e baseado em contingência, que inicia, gerencia e resolve os casos de recovery em nome dos clientes, com resultados como uma melhoria média anual de 75% na recuperação, retenção de clientes de 99% e recuperação de 100% dos reembolsos identificados, sem contato com os beneficiários. A empresa atende seguradoras, empregadores self-funded, third-party administrators, planos Medicare Advantage e Medicaid, além de outros tipos de pagadores, com foco em maximizar os reembolsos de subrogation e minimizar o atrito com os beneficiários e o esforço operacional.

Descrição

• Evaluate whether established case workflows, processes, and operating standards are followed consistently • Use established KPIs and performance signals to identify areas requiring investigation • Review operational activity across the healthcare claims and recovery lifecycle to identify breakdowns, inconsistencies, rework, delays, or unintended outcomes • Provide Recovery Operations leadership with clear, evidence-based findings regarding employee adherence, knowledge, training, or performance issues • Drive employee adoption of new processes and procedures and monitor adherence following implementation • Investigate operational and performance issues to determine underlying causes • Determine whether issues stem from process adherence, process design, workflow, technology, automation, data, capacity, or another operational factor • Analyze case activity, operational data, and workflow behavior to validate findings • Translate findings into clear recommendations and required outcomes • Coordinate process, workflow, system, or automation changes needed to resolve identified issues • Define business requirements, ownership, expected outcomes, and measures of successful resolution • Work across Recovery Operations, Technology, Product, Finance, Legal, and Client Services to move issues through resolution • Track issues, dependencies, and solutions through completion • Validate results after implementation • Coordinate and perform UAT for bug fixes, system changes, automation, and operational workflow improvements • Develop test scenarios based on healthcare claims, case management, and recovery workflows • Validate system changes and document testing results, defects, and unresolved issues • Maintain follow-through from issue identification through testing, deployment, and post-implementation validation • Lead and develop a small team of 5–7 employees

🎯 Requisitos

• 8+ years of direct professional experience in healthcare billing or health insurance operations is required; candidates without this experience will not be considered • 3+ years people management • Experience working with healthcare claims, billing, reimbursement, revenue cycle, payment integrity, subrogation, coordination of benefits, recovery, or related insurance workflows • Demonstrated ability to investigate healthcare operational issues and identify root causes across people adherence, process, workflow, technology, and data • Experience performing UAT for system defects, bug fixes, workflow changes, and technology implementations • Experience translating operational issues into clear business requirements and test scenarios • Strong analytical skills • Working knowledge of AI prompting, Power BI, and Excel • Ability to lead and develop a small team of 5–7 employees

🏖️ Benefícios

• Comprehensive medical, dental, and vision insurance • 401(k) retirement savings plan with employer match • Paid time off and paid holidays • Company-paid life insurance and short-term and long-term disability coverage • Employee Assistance Program with counseling, financial coaching, legal resources • Health Savings Account with company contributions for eligible employees • Wellness, healthcare advocacy, and pet benefits • A high-performing, collaborative culture built on ownership, accountability, continuous improvement, and meaningful impact

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