Operations Manager – Member Experience

VIVIO, a Public Benefit Corporation

. Support the overall operations of VIVIO's Member Experience organization, issue resolution and quality .

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

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in member experience operations, including issue resolution, quality assurance, and root cause analysis. Proficient in managing teams, tracking KPIs, and ensuring compliance with healthcare regulations while fostering strong client relationships.

Highest-signal resume keywords

Member Experience OperationsRoot Cause AnalysisTeam ManagementQuality AssuranceHealthcare Regulations Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Root Cause AnalysisPrior Authorization KnowledgePharmacy Claims ProcessingCRM ProficiencyExcel ProficiencyData AnalysisProcess MappingCorrective Action PlansQuality Program ManagementKPI Tracking

Soft Skills

Client CommunicationConflict ResolutionRelationship BuildingCoaching and DevelopmentPresentation Skills

Tools & Technologies

CRM SystemsClaims SystemsAI Tools

Industry Keywords

Healthcare OperationsPharmacy Benefit ManagementHIPAA ComplianceQueue-Based EnvironmentContact Center Management

About the role

Key responsibilities & impact

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

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 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

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