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.
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.
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.
Other duties as assigned.

Bachelor’s degree in Healthcare Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.
5+ years of experience in healthcare data operations, payer relations, or health informatics, with at least 2-4 years in a leadership or supervisory capacity.
Advanced proficiency in SQL for data investigation and root cause analysis; familiarity with data observability tools (e.g. Tableau) and SFTP protocols.
Deep understanding of payer data structures (claims, clinical feeds, care gaps) and healthcare quality reporting (HEDIS, MA Stars).
Proven ability to lead teams through complex technical troubleshooting and manage high-volume issue queues (e.g., Jira-based workflows).
Exceptional verbal and written communication skills, with a demonstrated ability to influence decision-makers and manage external payer relationships effectively.
Ability to translate complex data issues into actionable business insights and operational improvements.

Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options
And much more!

Manager, Payer Operations

Key skills