Operations Manager – Member Experience

VIVIO, a Public Benefit Corporation

. Serve as a primary point of contact for clients, consultants and vendors on member-facing issues, owning communication from intake to resolution .

Posted 10/28/2026full-timeRemote • United StatesMid-LevelSenior💰 $75,000 - $85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in member experience management, root cause analysis, and quality assurance within healthcare operations. Proficient in client communication, issue resolution, and team leadership to drive operational excellence and compliance.

Highest-signal resume keywords

Member Experience ManagementRoot Cause AnalysisQuality AssuranceTeam LeadershipHealthcare Regulations Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Root Cause AnalysisPrior AuthorizationPharmacy ClaimsCoordination Of BenefitsCorrective ActionsData AnalysisKPI TrackingProcess MappingCRM SystemsExcel Proficiency

Soft Skills

Client CommunicationConflict ResolutionRelationship BuildingCoachingTeam Development

Tools & Technologies

VIVIO's AI ToolClaims SystemsDocumentation Standards

Industry Keywords

Healthcare OperationsPBMHIPAAQuality ProgramEscalation Management

About the role

Key responsibilities & impact

Serve as a primary point of contact for clients, consultants and vendors on member-facing issues, owning communication from intake to 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 with 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
Track KPIs and audit case handling to drive improvement plans
Lead structured 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 to identify 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
Turn 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

What you’ll need

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 fulltime 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

Comp & perks

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