Job Description

The Manager, Payer Operations serves as the strategic leader overseeing the complex ecosystem of 130+ unique payer data integrations that directly impact patient care and practice success. In this critical role, you'll transform raw healthcare data into actionable insights while leading cross-functional teams through sophisticated technical challenges and serving as the trusted escalation point for high-priority data issues. You'll collaborate closely with Product, Technology, and Payer Strategy teams to influence the future of our data operations, moving from reactive troubleshooting to predictive, automated monitoring systems while ensuring compliance with healthcare regulations and maintaining the data integrity that enables providers to deliver exceptional patient care. This position combines strategic thinking with hands-on problem-solving, requiring you to translate complex technical data challenges into business solutions that keep our healthcare partners running smoothly and focused on what matters most: caring for patients.

Candidates should be comfortable working remotely/work from home anywhere within the US.

Primary Duties:

Operational Strategy & Oversight

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.

Cross-Functional Collaboration

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.

Compliance & Quality Assurance

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.

Minimum Qualifications:

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.

Preferred Qualifications:

Master’s degree in Healthcare Administration, Business Administration, Data Analytics, Information Systems, or a related field, or equivalent experience.

Experience in value based care

Experience promoting or selling to physicians, physician practices or related associations

Experience leading cross-functionally within a complex organization

Proactive self-starter with the ability to lead in a fast-paced environment, with the ability to work independently, as part of a team, and as a leader

Manager, Payer Operations (Remote) - Aledade

Primary Duties:

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