Operations Director – Healthcare

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We are seeking an experienced, high-caliber Operations Director to lead and scale our end-to-end healthcare BPO operations based in Binondo, Manila. This role owns full operational leadership, P&L accountability, and service delivery excellence across 4 dedicated Lines of Business, with a total workforce of 800+ FTEs.You will oversee complex, specialized workflows for global healthcare clients, enforce strict regulatory compliance, drive process standardization across LOBs, and lead large cross-functional leadership teams. The ideal candidate has deep domain expertise across payer, provider, clinical, and pharmaceutical services, and a proven history of successfully managing large-scale healthcare operations.

You will provide unified strategic and operational leadership across these four specialized service lines:

1. Healthcare Payer Services – Claims adjudication & processing, member enrollment & eligibility, premium billing, provider credentialing, appeals & grievances, payment reconciliation, and underwriting support.
2. Healthcare Solutions – Medical billing & coding, clinical documentation integrity, patient support & care coordination, prior authorization, revenue cycle management (RCM), provider back-office, and health information management.
3. Life Sciences & Pharmaceutical Services – Clinical trial support, pharmacovigilance & adverse event reporting, drug safety processing, patient assistance programs, pharmaceutical sales support, regulatory compliance documentation, and supply chain admin.

• Develop and align operational strategies, SLAs, and targets specific to the unique requirements of each of the 4 LOBs, while maintaining consistent company-wide standards.
• Oversee daily delivery across all accounts; ensure seamless 24/7 operations for 800+ FTEs distributed across payer, solutions, and life science/pharmaceutical teams.
• Own full P&L responsibility; manage multi-million budgets, cost efficiency, capacity planning, ramp-up/down cycles, and resource allocation across all service lines.
• Establish standardized operational frameworks, playbooks, and escalation protocols while preserving the specialized workflows required for each LOB.
• Lead cross-LOB initiatives to share best practices, optimize workforce utilization, and leverage synergies between service lines.

• Ensure full adherence to all applicable regulations for every service line: HIPAA, HITECH Act, GDPR, Data Privacy Act of 2012 (Philippines), FDA regulations, ICH-GCP, and local healthcare/pharmaceutical industry standards.
• Implement LOB-specific Quality Assurance (QA) programs: accuracy audits, compliance reviews, clinical validation checks, and regulatory reporting compliance.
• Oversee end-to-end security for Protected Health Information (PHI), clinical trial data, pharmaceutical intellectual property, and sensitive payer/provider records.
• Lead internal and external audits, client compliance assessments, and regulatory inspections; ensure corrective actions are completed within required timelines.
• Update policies and workflows immediately in response to changes in healthcare, insurance, or pharmaceutical regulations.

• Directly manage a leadership team including Operations Managers, LOB Heads, Account Managers, QA Leads, WFM Heads, and Training Managers; indirectly lead and support 800+ frontline associates.
• Design LOB-specific training, upskilling, and certification programs – covering medical terminology, coding standards, insurance rules, pharmacovigilance protocols, and regulatory requirements.
• Drive performance management, attrition reduction, succession planning, and career pathing tailored to the specialized skills needed for each service line.
• Foster a culture of accuracy, confidentiality, empathy, and continuous improvement aligned with the ethics of healthcare and life sciences.

• Act as the primary executive operational lead for key clients across all four LOBs: health insurers, hospitals & health systems, pharmaceutical companies, biotech firms, and healthcare technology providers.
• Deliver monthly/quarterly business reviews, present performance against custom SLAs, and proactively propose improvements aligned with each client’s industry segment.
• Partner with Sales & Business Development to support new account onboarding, transition management, renewals, and upselling across payer, solutions, and life science/pharmaceutical offerings.
• Coordinate cross-functionally with HR, Finance, IT, Compliance, and Facilities to resolve operational risks and deliver seamless service.

• Define and monitor LOB-specific KPIs: claims accuracy, first-pass resolution, coding accuracy, adverse event reporting timelines, SLA attainment, client satisfaction, and schedule adherence.
• Lead process improvement initiatives (Six Sigma, Lean, Kaizen) to reduce errors, improve turnaround times, lower costs, and enhance compliance across all service lines.
• Prepare consolidated operational reports for the Executive Team, highlighting performance by LOB, risks, and strategic recommendations.
• Proactively anticipate volume shifts, regulatory changes, or resource needs and implement mitigation plans to prevent service disruptions.

• Bachelor’s degree in Nursing, Health Administration, Business Administration, Medical Technology, Pharmacy, Public Health, or a related field.
• MBA, Master’s in Healthcare Administration, or certification in Healthcare Compliance / Revenue Cycle / Pharmacovigilance is a strong advantage.

• Minimum 10–12 years progressive experience in BPO/contact center operations.
• At least 7 years in senior leadership roles exclusively within Healthcare BPO.
• Non-negotiable: Proven track record directly managing or supporting 800+ FTEs across multiple healthcare service lines.
• Demonstrated exposure to at least 2–3 of the required LOBs: 
  • Healthcare Payer: claims processing, eligibility, benefits, appeals
  • Healthcare Solutions: medical billing/coding, RCM, patient support
  • Life Sciences & Pharma: pharmacovigilance, clinical trial support, patient assistance
• Deep knowledge of HIPAA, Data Privacy Act of the Philippines, and relevant pharmaceutical/healthcare regulatory frameworks.
• Experience managing 24/7 multi-shift operations for US, EU, and APAC clients.

• Strong domain knowledge across payer, provider, and life science/pharmaceutical business models.
• Proven financial acumen and P&L management experience for large-scale operations.
• Proficiency in WFM tools, healthcare systems (Epic, Cerner, Meditech, etc.), billing platforms, and CRM software.
• Exceptional strategic planning, crisis management, and decision-making skills.
• Excellent communication and presentation skills for C-level and regulatory stakeholder interactions.