Sr. Manager, Operations - Proview & Enrollhub

Sunshine State Health Plan, Inc. Washington , DC 20319

Posted 2 months ago

Position Summary:

The Senior Manager, Operations (ProView & EnrollHub) is responsible for ensuring organizational effectiveness and goal achievement by providing management of the on-going operational and administrative components of CAQH products. General responsibilities include the following:

Supporting and executing strategic CAQH initiatives with an eye towards cost reduction and improving efficiency.

  • Supporting customer needs and resolving issues.

  • Managing vendor services.

  • Supporting provider engagement and utilization of assigned CAQH products.

  • Executing customer and internal projects as needed; including implementation for new customers and expanding services to current customers.

The Senior Manager, Operations (ProView & EnrollHub) position requires a demonstrated ability to manage vendor and CAQH processes, develop and execute plans, manage and improve business processes, and monitor and report operational results. The position is responsible for working with both internal and customer technical teams to implement, run and troubleshoot business processes.

Working with the management team, the position also contributes to the development and implementation of product strategies, policies and practices. Position also responsible for budget and forecast assumptions and business case development in partnership with the Director, Operations. This role is full-time, exempt and reports to the Director, Operations.

Specific Responsibilities:

Vendor Management:

  • Increase effectiveness and efficiency of service by planning and implementing improvements to service offerings.

  • Manage vendor in its delivery of all services; document processing and financial processing for CAQH products and related programs; SLA reporting and overall performance monitoring.

  • Incident management, including break-fix reporting, analysis, resolution and escalation as necessary.

Audit and Compliance:

Develop and maintain all relevant program operational documentation for both CAQH and vendor relating to service delivery and business processes.

Monitor all services to ensure compliance with vendor and customer contracts.

Support audit activities around regulatory compliance.

Deliver ad hoc audit reports at customer request.

Customer Support:

Respond to customer needs and inquiries related to system usage, functionality and data.

Manage user interactions and communications relating to CAQH product functionality and utilization including education and problem resolution.

Liaison between CAQH Account Management team and vendor helpdesk.


Responsible insuring that implementations are coordinated with vendor teams as needed.

Prioritizes operations team support to assist implementations team as needed.

Other Duties:

  • Learn and show proficiency in the functions of all CAQH solutions. Must be able to proficiently conduct presentations and demonstrations of CAQH solutions.

  • Support high visibility CAQH projects required to move strategic initiatives forward.

  • Propose process improvements and provide regular updates to management team.

Supervisory Responsibility:

Position is responsible for directing and supervising both internal (CAQH) and external vendor staff.

Responsible for designing and growing a successful support team through team member mentoring with a focus on career growth and succession planning.


Strong focus on customer service excellence and a positive user experience.

Strong data management skills with the ability to effectively communicate business needs to technical resources.

Highly organized and efficient, with excellent follow-up skills.

Strong and persuasive communication skills (written and verbal).

Ability to manage BPO Vendors for contract compliance and service delivery.

Excellent abilities to direct and manage existing business processes while continuously looking for process improvement opportunities.

Ability to transform details and facts into recommendations and action plans.

Ability to produce policy and process documentation.

Ability to look at situations from several points of view.

Analytical mindset with ability to creatively solve problems.

Excels at operating in a fast pace and changing environment.

Displays consistent professionalism and good judgment.

Microsoft Office applications proficiency required, and SalesForce experience a plus.


Seven plus years of experience managing operations, with emphasis on customer service delivery. Experience in a healthcare payer environment a plus.

Ongoing self-development to maintain expertise in operations management and process improvement.


Bachelor's degree required; business and technology disciplines preferred.

Certification Requirements:



Named one of Modern Healthcare's Best Places to Work in 2016, 2017, 2018 and 2019, CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans.

  • COB Smart quickly and accurately directs coordination of benefits processes.

  • EnrollHub reduces costly paper checks with enrollment for electronic payments and electronic remittance advice.

  • CAQH ProView eases the burden of provider data collection, maintenance and distribution.

  • DirectAssure increases the accuracy of health plan provider directories.

  • VeriFideTM streamlines credentialing by consolidating and standardizing primary source verification.

  • SanctionsTrack delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions.

  • CAQH CORE maximizes business efficiency and savings by developing and implementing national operating rules.

  • CAQH Index benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions.


CAQH recognizes that its most important asset is its growing team of smart, creative, collaborative, forward-thinking and passionate professionals - and that a comprehensive employee benefits package is an important factor for them in choosing where to work. CAQH offers competitive compensation along with an extensive benefits package for all full-time employees, including medical, dental and vision coverage, tuition assistance and a 401k. Our location in downtown Washington, DC is metro-accessible, has an onsite fitness center and is centrally located to allow our team to take advantage of professional networking opportunities, cultural offerings and a thriving social scene.

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Sr. Manager, Operations - Proview & Enrollhub

Sunshine State Health Plan, Inc.