Manager – Retrieval Operations

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the daily operations of Reveleer’s retrieval program for a significant customer launch involving around 500,000 chases set to begin with the October 2026 go-live.

• Take ownership of daily and weekly chase queue management, tracking retrieval rates, pend rates, and AID ownership across approximately one million annual chases.

• Manage chase-to-AID assignments and modify workflows in response to changes in volume and provider mix.

• Address aged and at-risk chases and escalate any systemic barriers to retrieval.

• Supervise the performance of AI-driven platform voice agents that assist with retrieval outreach.

• Track agent-to-human conversion rates and outcome metrics while identifying areas for optimization.

• Maintain PSR staffing models and capacity forecasts considering volume, seasonality, and agent-enabled throughput.

• Collaborate with the India retrieval team to ensure alignment between onshore and offshore capacities.

• Act as the primary operational contact for the retrieval relationship on a day-to-day basis.

• Work with Onboarding & Data Management to address data quality and provider-matching challenges.

• Coordinate retrieval escalations related to providers and members with Customer Support.

• Generate the Chase Status Underlying Report analysis and maintain tracking for retrieval, pend, and escalation metrics.

• Create weekly and monthly scorecards for Reveleer and customer leadership.

• Contribute performance narratives and data for quarterly business review materials.

• Lead root-cause analysis for retrieval shortfalls, provider access challenges, and agent performance deficiencies.

• Establish escalation protocols across Retrieval Services, Clinical Operations, and Engineering.

• Drive corrective action plans to completion and ensure sustained improvements.

• Identify opportunities to broaden AI agent-enabled retrieval to include additional chase types or provider segments.

• Document and enhance standard operating procedures for the blended agent and PSR retrieval model.

• Share lessons learned from the launch with colleagues involved in other RISK, HEDIS, and IVA programs.

⛳️ Requirements

• A minimum of 5 years of experience in healthcare operations, chart retrieval, risk adjustment, or management of HEDIS/quality programs.

• At least 2 years of experience in directly managing a team of individual contributors, including aspects of performance management and coaching.

• Proven experience in managing large-scale, high-volume retrieval or outreach programs within defined SLAs.

• Familiarity with risk adjustment and HEDIS retrieval workflows, encompassing chase, AID, and pend code concepts.

• Comfort with AI-enabled or automated outreach tools, including performance monitoring and identifying optimization opportunities.

• Strong analytical capabilities, including proficiency in Excel; experience with Python or SQL for data analysis is advantageous.

• Demonstrated ability to develop and maintain staffing and capacity forecasting models.

• Exceptional written and verbal communication skills, with experience in presenting performance data to customers or senior leadership.

• Capacity to manage multiple priorities in a fast-paced, deadline-oriented environment.

• Direct experience with Medicare Advantage or ACA health plan customers is preferred.

• Experience in a business process outsourcing (BPO) or shared services operating model, including coordination with offshore teams is preferred.

🏝️ Benefits

• Competitive salary

• Medical, Dental and Vision benefits

• 401k with Employer Match

• Generous PTO plan