Operations Manager

About This Role

POSITION SUMMARY

The Operations Manager is responsible for leading overall service operations, overseeing Third Party Administrator (TPA) relationships, driving operational excellence, and ensuring effective service delivery across claims, policy administration, and broker-facing operations. This role acts as a key liaison between internal stakeholders, TPAs, brokers, and strategic partners to ensure compliance, efficiency, and high-quality service outcomes.### DUTIES AND RESPONSIBILITIES

The essential functions include, but are not limited to the following:

Service Operations Leadership* Lead the overall service operations, ensuring alignment with organizational goals and business objectives.

• Ensure service delivery meets agreed SLAs, quality benchmarks, and client expectations.
• Liaise with multiple areas of the business to improve customer experience for both end customers and distribution partners. TPA Management & Governance* Manage end-to-end relationships with TPAs, including contract governance and performance management.
• Monitor KPIs, service levels, and operational performance metrics.
• Train TPA staff on full policy wording and the company’s risk management philosophy.
• Oversee TPA invoices, fee management, and claim float reviews. Escalations & Service Management* Act as the key escalation point for TPA-related operational and customer service issues.
• Engage with TPA leadership to resolve issues and continuously improve service quality. Major Claims & Outlier Reviews* Review high-value, complex, or exceptional claims.
• Support fraud and outlier case reviews in coordination with claims and compliance teams. Operational Oversight* Ensure accurate and timely flow of policy issuance and renewal data to TPAs.
• Drive utilization reviews and benefit enhancement recommendations. Policy Wording Management* Lead annual policy wording reviews incorporating inputs from TPAs, brokers, and internal stakeholders.
• Coordinate policy updates with Marketing, Compliance, Product, and IT. Process Improvement, Digital Transformation & Projects* Oversee and actively participate in the Digital Transformation Review.
• Lead and support operational improvement and transformation initiatives.
• Collaborate with internal teams (Claims, IT, Compliance, Operations, Finance) and external partners.

Broker Engagement

• Manage broker interactions related to operational and service matters.
• Participate in broker meetings and support operational training initiatives. People Management & Talent Acquisition* Lead teams across claims handling, payments, and policy administration.
• Set KPIs, manage performance, and mentor team members.
• Spearhead talent acquisition efforts to build a high-performing operations team.

MINIMUM QUALIFICATIONS (KNOWLEDGE, SKILLS, AND ABILITIES)

Experience & Background* 7–10 years of experience in the insurance sector.

• Minimum of 5 years of experience in IPMI (International Private Medical Insurance).
• Strong exposure to claims, operations, and broker- or customer-facing roles.
• Proven experience in managing teams and complex operational processes. Skills & Competencies* Strong stakeholder management and communication skills.
• Ability to lead initiatives and manage multiple priorities independently.
• Comfortable navigating complex policy wordings and operational workflows.
• Strong analytical and problem-solving skills.
• Proficient in MS Excel and MS Office.

OTHER DETAILS

Supervisory Responsibilities

Yes#### Work Environment

The noise level in the work environment is usually low to moderate.#### Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus.#### Travel Requirements

NOTE

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise. The Company complies with employment regulations as they apply to the location of service.