What are the responsibilities and job description for the Contact Center Operations Manager (Member Services Operations Manager) position at ClaimDOC?
ClaimDOC is a national medical claim auditing and member advocacy company driven to deliver a successful and sustainable health plan for employers and their employees. By combining innovative technology, industry-leading data, and healthcare expertise, we deliver fair reimbursement solutions that improve plan sustainability, enhance the member experience, and support providers with ethical, transparent payments.
Our team is passionate about simplifying healthcare for employers, members, and providers through advocacy, education, and exceptional service. We are committed to helping organizations build stronger health plans while ensuring employees have the guidance and support they need to confidently navigate their healthcare benefits.
Job Summary
The member service operations manager is responsible for the administration and continuous improvement of the organization’s contact center operations and technology platforms. This role leads the design and optimization of end-to-end contact center processes, including call flows, workforce management, quality assurance, knowledge management, and service delivery standards. The position serves as the primary administrator for the NiCE CXOne platform and partners closely with IT and business stakeholders to enhance operational efficiency, member advocate performance, and customer experience.
The ideal candidate brings extensive contact center leadership experience, strong technical expertise in contact center platforms, and a proven ability to leverage data, reporting, and workforce management practices to improve service levels, operational performance, and scalability. This individual will collaborate across Member Relations, Provider Relations, Claims, and IT teams to align workflows, support multi-channel communication strategies, and provide actionable insights to leadership that drive business outcomes and future investment decisions.
Essential Duties and Responsibilities
Design, document, and continuously optimize contact center processes across the full lifecycle — call flows, knowledge base, SOPs, and Quality Assurance
Assess current-state operations across service demand, channel strategy, workforce management, agent experience, technology capabilities, cost structure, and performance metrics
Administer and manage the NiCE CXOne platform, including configuration, routing, IVR, and reporting.
Track and optimize contact center SLAs and KPIs for both inbound and outbound operations.
Define and implement Workforce Management processes, including forecasting, scheduling, adherence, and capacity planning for 70 agents
Partner with the IT team on the direction, management, and roadmap of the contact center platform and supporting systems
Collaborate closely with Member Relations, Provider Relations, and Claims teams to align workflows and support cross-functional service delivery
Provide regular reporting and insights to ClaimDOC leadership on contact center performance, opportunities, and investment needs
Qualifications
5–10 years of progressive contact center leadership or senior operations experience
Hands-on experience administering enterprise contact center platforms (call routing, IVR, reporting, integrations)
Proven experience designing and optimizing contact center processes across the full lifecycle — call flows, knowledge base, SOPs, and Quality Assurance
Track record of defining, measuring, and improving contact center KPIs and SLAs
Experience defining and implementing Workforce Management processes (forecasting, scheduling, adherence, capacity planning)
Demonstrated success partnering with IT, operations, and business teams to drive shared outcomes
Required Technical Experience
Contact center platform administration (non-negotiable)
NiCE CXOne experience strongly preferred
Strong analytical and reporting skills — comfortable using data to define and track performance
Familiarity with multi-channel contact center capabilities (chat, email, SMS, self-service)
Preferred Experience
Healthcare industry experience (TPA, self-funded benefits, health plan, or provider services) not required
Experience applying data and AI/automation to contact center use cases (agent assist, knowledge surfacing, conversational analytics)
Experience developing business cases, transformation roadmaps, operating models, performance improvement plans, or value realization frameworks
Experience expanding a voice-only contact center into multi-channel operations
Experience supporting outbound-heavy workloads (current mix is ~75% outbound / 25% inbound)
Certifications such as COPC, ICMI, or Six Sigma
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.
Our team is passionate about simplifying healthcare for employers, members, and providers through advocacy, education, and exceptional service. We are committed to helping organizations build stronger health plans while ensuring employees have the guidance and support they need to confidently navigate their healthcare benefits.
Job Summary
The member service operations manager is responsible for the administration and continuous improvement of the organization’s contact center operations and technology platforms. This role leads the design and optimization of end-to-end contact center processes, including call flows, workforce management, quality assurance, knowledge management, and service delivery standards. The position serves as the primary administrator for the NiCE CXOne platform and partners closely with IT and business stakeholders to enhance operational efficiency, member advocate performance, and customer experience.
The ideal candidate brings extensive contact center leadership experience, strong technical expertise in contact center platforms, and a proven ability to leverage data, reporting, and workforce management practices to improve service levels, operational performance, and scalability. This individual will collaborate across Member Relations, Provider Relations, Claims, and IT teams to align workflows, support multi-channel communication strategies, and provide actionable insights to leadership that drive business outcomes and future investment decisions.
Essential Duties and Responsibilities
Design, document, and continuously optimize contact center processes across the full lifecycle — call flows, knowledge base, SOPs, and Quality Assurance
Assess current-state operations across service demand, channel strategy, workforce management, agent experience, technology capabilities, cost structure, and performance metrics
Administer and manage the NiCE CXOne platform, including configuration, routing, IVR, and reporting.
Track and optimize contact center SLAs and KPIs for both inbound and outbound operations.
Define and implement Workforce Management processes, including forecasting, scheduling, adherence, and capacity planning for 70 agents
Partner with the IT team on the direction, management, and roadmap of the contact center platform and supporting systems
Collaborate closely with Member Relations, Provider Relations, and Claims teams to align workflows and support cross-functional service delivery
Provide regular reporting and insights to ClaimDOC leadership on contact center performance, opportunities, and investment needs
Qualifications
5–10 years of progressive contact center leadership or senior operations experience
Hands-on experience administering enterprise contact center platforms (call routing, IVR, reporting, integrations)
Proven experience designing and optimizing contact center processes across the full lifecycle — call flows, knowledge base, SOPs, and Quality Assurance
Track record of defining, measuring, and improving contact center KPIs and SLAs
Experience defining and implementing Workforce Management processes (forecasting, scheduling, adherence, capacity planning)
Demonstrated success partnering with IT, operations, and business teams to drive shared outcomes
Required Technical Experience
Contact center platform administration (non-negotiable)
NiCE CXOne experience strongly preferred
Strong analytical and reporting skills — comfortable using data to define and track performance
Familiarity with multi-channel contact center capabilities (chat, email, SMS, self-service)
Preferred Experience
Healthcare industry experience (TPA, self-funded benefits, health plan, or provider services) not required
Experience applying data and AI/automation to contact center use cases (agent assist, knowledge surfacing, conversational analytics)
Experience developing business cases, transformation roadmaps, operating models, performance improvement plans, or value realization frameworks
Experience expanding a voice-only contact center into multi-channel operations
Experience supporting outbound-heavy workloads (current mix is ~75% outbound / 25% inbound)
Certifications such as COPC, ICMI, or Six Sigma
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. ClaimDOC Is a drug- and tobacco-free workplace.
Benefits:
Health Insurance, Vacation & Paid Time Off