Operations Manager Healthcare Payer Operations
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Location: Coppell, Texas
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Work Arrangement: Onsite Daily Office Presence Required
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Employment Type: Full-Time
About the Role
Nexillo is hiring an experienced Operations Manager to lead day-to-day healthcare operations within a payer environment.
The primary focus of this role is managing operational functions such as claims, eligibility, enrollment, billing, member services, provider support, vendor performance, reporting, and process improvement.
Experience supporting Medicare plans is preferred. Knowledge of self-funded health plans, Third-Party Administrator operations, stop-loss, or Pharmacy Benefit Managers is a plus but not required.
What You ll Do
Manage daily healthcare payer operations.
Oversee claims, eligibility, enrollment, billing, reconciliation, and member services.
Monitor service levels, turnaround times, accuracy, productivity, and operational KPIs.
Resolve escalated issues involving members, providers, clients, claims, or vendors.
Develop and improve workflows, standard operating procedures, controls, and escalation processes.
Prepare operational reports, dashboards, trend analyses, and leadership updates.
Coordinate with provider networks, PBMs, utilization-management vendors, technology partners, and internal teams.
Support client implementations, plan transitions, system migrations, and vendor changes.
Ensure compliance with HIPAA, CMS requirements, ACA, COBRA, and other applicable regulations.
Hire, train, mentor, and manage operations team members.
Drive accountability, service quality, collaboration, and continuous improvement.
What We re Looking For
Five or more years of healthcare operations experience within a health plan, payer, managed-care organization, benefits administrator, or similar environment.
Strong knowledge of claims, eligibility, enrollment, billing, member services, and payer operations.
Experience managing teams, vendors, service levels, escalations, and operational performance.
Strong leadership, communication, analytical, organizational, and problem-solving skills.
Ability to manage multiple priorities in a fast-paced environment.
Must be available to work onsite daily in Coppell, Texas.
Preferred Experience
Medicare Advantage, Medicare Supplement, Medicare Part D, or other Medicare plan operations.
CMS requirements and Medicare operational processes.
Self-funded health plans or TPA operations.
Stop-loss or reinsurance coordination.
Pharmacy Benefit Manager operations.
Utilization management, care management, provider networks, or healthcare cost containment.
Claims-platform implementations or migrations.
Healthcare claims systems, CRM platforms, reporting tools, or data exchanges.
Key Skills
Healthcare Operations | Payer Operations | Medicare | Claims Administration | Eligibility and Enrollment | Member Services | Provider Operations | Vendor Management | Operational KPIs | Regulatory Compliance | Process Improvement | Team Leadership
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