Manager, Payer Operations

Operational Strategy & Oversight:

• Establish and monitor performance metrics (KPIs) to measure the reliability, latency, and saturation of payer data feeds.
• Define and refine standard operating procedures (SOPs) for data issue triage, clinical ingestion troubleshooting, and Primary Source Verification (PSV) audits.
• Lead discovery efforts for long-term data operations and technical requirements to transition from reactive troubleshooting to proactive monitoring.

Cross-Functional Collaboration:

• Serve as the primary point of escalation for high-priority payer data issues, coordinating closely with Payer Strategy & Engagement (PSE), Health Plan Partnerships (HPP), Product, and Technology teams.
• Partner with Product teams to identify systemic data ingestion failures and influence the product roadmap for automated monitoring solutions.
• Support the Care Gap operations team by overseeing investigations into manual upload failures and measure mapping exercises.

Compliance & Quality Assurance:

• Oversee the documentation and submission processes for HEDIS and other clinical data extracts to ensure audit readiness.
• Ensure all team activities comply with healthcare regulations and data security standards.