Operations Manager – Member Experience

Job not on LinkedIn

🔥 7 minutes ago

🇺🇸 United States – Remote

💵 $75k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

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VIVIO, a Public Benefit Corporation

WebsiteLinkedInAll Job Openings

51 - 200 employees

💼 Consulting

🛡️ Insurance

📦 Logistics

Consulting • Insurance • Logistics

VIVIO is a Public Benefit Corporation specializing in drug management solutions. The company utilizes data intelligence to provide personalized drug therapies, leveraging clinical trial data and market prices to ensure patients receive the right medication at the right price without unnecessary middlemen or markups. VIVIO offers an alternative to traditional Pharmacy Benefit Manager (PBM) models by providing a transparent and cost-effective approach to drug pricing and management. Their services focus on reducing prescription costs while improving outcomes and maintaining compliance, specifically targeting specialty drugs and broader drug management needs for organizations.

📋 Description

• Support the overall operations of VIVIO's Member Experience organization, issue resolution and quality • Serve as a primary point of contact for clients, consultants and vendors on member-facing issues from intake through resolution • Lead issue review calls and deliver written resolution summaries covering timeline, member impact, root cause, corrective actions and follow-up commitments • Handle difficult conversations while balancing partner expectations, contract terms, regulatory requirements and operational realities • Build trusted relationships and present issue trends, quality results and improvements in client and consultant business reviews • Prioritize member-facing issues by urgency and impact and serve as the final internal escalation point for complex member, pharmacy, prescriber and payer issues • Coordinate with providers, pharmacies, vendors and internal teams to resolve cases and confirm member outcomes • Maintain intake, triage, SLA and documentation standards and streamline workflows delaying medication fills or other member services • Track KPIs and audit case handling to drive improvement plans • Lead root cause analysis using 5 Whys, fishbone diagrams, Pareto analysis and process mapping • Own corrective and preventive action plans and confirm fixes are sustained • Analyze trends and partner with cross-functional teams to address recurring failure points and emerging risks • Lead the quality program, including call and case audits, scorecards, evaluator calibration and feedback • Ensure adherence to policies, contracts, HIPAA and healthcare regulations and support audits • Convert quality findings into root cause inputs, training recommendations, job aids and updated SOPs • Serve as the team's expert on VIVIO's AI tool, coach staff, review AI-assisted interactions and identify automation opportunities • Coach and develop team leads and staff, manage schedules, goals and performance reviews, and build a culture of ownership and member-first service • Report issue, escalation, quality and root cause trends to leadership with data-driven insights and corrective-action progress

🎯 Requirements

• 3+ years in member experience, PBM, pharmacy claims or related healthcare operations • 2+ years managing teams in a queue-based or contact center environment, including escalations or quality assurance • Client-facing experience resolving member-facing issues directly with clients, consultants or vendors and communicating resolution and root cause • Proven root cause analysis experience, with concrete examples of sustainable corrective actions • Knowledge of prior authorization, coordination of benefits, pharmacy claim rejections and HIPAA • Proficiency with CRM or claims systems and Excel, including pivot tables • High school diploma or equivalent • Currently authorized to work in the United States on a full-time basis without employer support, visa transfer support, DSO documentation or sponsorship now or in the future • Remote work with extended computer and phone use • On-call for urgent escalations and occasional extended hours, including partner calls outside business hours • Preferred: Bachelor's degree in healthcare administration, business or a related field • Preferred: Specialty pharmacy, mail order or long-term care experience • Preferred: Experience presenting to clients or executives

🏖️ Benefits

• Bonus eligible • Health benefits • 401K with employer match • Stock options • PTO • Opportunity to work in a fast-moving, collaborative, and innovative company • Limited travel for VIVIO meetings, training and client or vendor visits