Manager, Customer Success Operations
The Manager, Customer Success Operations leads Tier 2 operations responsible for complex case resolution, service recovery, operational SLA performance, root cause analysis, and defect reduction. This role converts customer issue patterns into scalable process improvements and ensures complex customer matters are resolved accurately, timely, and with clear ownership.
About the Company
Antidote Health is a tech-driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.
Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.
We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.
Position Overview
The Manager, Customer Success Operations leads Tier 2 operations responsible for complex case resolution, service recovery, operational SLA performance, root cause analysis, and defect reduction. This role converts customer issue patterns into scalable process improvements and ensures complex customer matters are resolved accurately, timely, and with clear ownership. Antidote Health's mission is to redefine healthcare by providing affordable, high-quality, accessible care and insurance products. The Customer Success organization supports that mission by making healthcare easier to understand, easier to access, and easier to navigate for members, brokers, patients, providers, and internal partners.
Key Responsibilities
- Lead Tier 2 Customer Success Operations, including complex case teams, Team Lead II oversight, backlog management, SLA performance, and escalated operational workflows.
- Establish and maintain operational standards for case ownership, customer updates, documentation, escalation quality, and cross-functional handoffs.
- Use data to identify repeat contacts, broken processes, system issues, policy gaps, and operational defects that drive customer dissatisfaction.
- Partner with Billing, Finance, Claims, Enrollment, Network, Product, Engineering, Clinical Operations, Sales, Compliance, Tier 1, and Tier 3 to resolve systemic issues.
- Develop and maintain Tier 2 SOPs, workflow documentation, case templates, escalation criteria, and quality standards.
- Drive process improvement initiatives designed to reduce complaint volume, improve first-touch routing, reduce rework, and strengthen customer trust.
- Manage, coach, and develop Tier 2 Team Leads and Specialists.
- Provide leadership reporting on backlog health, aging, SLA compliance, root cause themes, customer impact, and corrective actions.
- Support OEP readiness, staffing plans, training needs, and operational contingency planning.
- Ensure operations comply with HIPAA, privacy, CMS, ACA, state, and internal requirements.
Qualifications
Required:
- 5 or more years of healthcare, health insurance, customer operations, claims, billing, eligibility, enrollment, or service operations experience.
- 3 or more years of leadership experience in a contact center, health plan, shared services, claims, billing, enrollment, or customer operations environment.
- Strong understanding of claims, billing, eligibility, enrollment, provider access, member financial responsibility, and customer escalation workflows.
- Demonstrated experience managing SLAs, operational inventory, process improvement, and cross-functional work streams.
- Ability to analyze trends, build action plans, and communicate operational risks to senior leadership
Preferred:
- ACA marketplace or commercial health plan experience.
- Experience with Salesforce, Five9, claims systems, eligibility systems, payment systems, WFM platforms, QA tools, and dashboards.
- Lean, Six Sigma, project management, or process improvement certification.
- Experience managing transformation, vendor handoffs, offshore support models, or operational redesign
- Bachelors degree in healthcare administration, business, operations, analytics or a related field is preferred
Work Shift and Training Expectations
- Shift flexibility may be required based on operational needs, including extended hours, overtime, weekends, holidays, or Open Enrollment Period support.
- Specific shift assignments are based on business needs and should be confirmed during the recruiting and offer process.
- Completion of required Antidote Health onboarding and role-based training.
- Completion of HIPAA, privacy, security, compliance, systems, and workflow training.
- Participation in quality coaching, calibration, refresher training, and ongoing competency checks as assigned.
Competencies
- Ownership and accountability: works issues to resolution rather than transferring responsibility unnecessarily.
- Member and customer advocacy: seeks to understand the customer goal, the barrier, the accountable owner, and the fastest compliant path to resolution.
- Clear communication: translates benefits, eligibility, deductibles, claims, referrals, prior authorization, premiums, and other healthcare concepts into plain language.
- Critical thinking: identifies root causes, asks investigative questions, and recognizes when an issue does not align with expected process or system behavior.
- Calm authority: communicates findings with accuracy, confidence, and professionalism while avoiding speculation.
- Emotional intelligence and de-escalation: steadies difficult interactions and maintains professionalism under pressure.
- System fluency: navigates CRM, claims, eligibility, benefits, provider lookup, payment, scheduling, knowledge base, and case management tools efficiently.
- Compliance mindset: maintains HIPAA, privacy, CMS, ACA, state DOI, and internal policy requirements.
- Documentation discipline: records clear, complete, and audit-ready notes that support continuity and accountability.
- Adaptability and resilience: succeeds in a fast-paced, evolving health plan environment
Compensation and Benefits
- Base salary range: $85,000-107,000 (commensurate with experience and location)
- Comprehensive benefits package including medical, dental, vision
- 401(k)
- Paid vacation and sick time and company holidays
- This role is eligible to be performed remotely
Company Standards and Expectations
- Employment is at-will, meaning either the employee or the company may terminate employment at any time, with or without cause, in accordance with applicable law
- Employees are expected to adhere to all company policies, including confidentiality, data protection, and code of conduct
- Responsibilities may evolve based on business needs, and flexibility is expected as the company scales
- Compliance with all applicable federal, state, and local laws and regulations is required
Equal Opportunity Statement
Antidote Health is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other protected status under applicable law.
