Director, Operational Quality & Governance
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Job Location:
Saint Louis, MI - USA
Monthly Salary:
Not Disclosed
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
At Zelis we Get Stuff Done. So lets get to it!
A Little About Us
Zelis is modernizing the healthcare financial experience across payers providers and healthcare consumers. We serve more than 750 payers including the top five national health plans regional health plans TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify optimize and solve problems holistically with technology built by healthcare experts driving real measurable results for clients.
A Little About You
You bring a unique blend of personality and professional expertise to your work inspiring others with your passion and dedication. Your career is a testament to your diverse experiences community involvement and the valuable lessons youve learned along the way. You are more than just your resume; you are a reflection of your achievements the knowledge youve gained and the personal interests that shape who you are.
Position Overview
The Director Operational Quality & Governance is responsible for leading the enterprise Quality function across Payments Operations ensuring operational processes are productive effective compliant and continuously improving.This role oversees quality monitoring builds and governs quality standards and leads the transformation of Quality through AI-enabled capabilities. The Director will convert quality data into actionable intelligence shifting the organization to drive signal-driven process improvement.
Reporting to the VP Operational Excellence this leader manages an established quality team and partners cross-functionally with Operations Compliance Technology and AI teams to elevate quality standards across the Payments business.
What Youll Do:
Oversee daily execution of call monitoring and quality scoring processes.
Own quality scorecards and evaluation frameworks including compliance customer experience and service effectiveness criteria.
Ensure consistency fairness and calibration across evaluators to minimize scoring variability.
Establish governance for quality standards scorecards checklists peer audit requirements audit protocols and performance thresholds ensuring formal documentation version control and periodic review.
Partner with Operations leaders to drive targeted improvement plans based on quality outcomes.
Maintain strict adherence to regulatory contractual and compliance requirements embedded within scoring models.
Serve as business co-owner of AI-enabled quality capabilities.
Define the post-MVP roadmap for scaling AI-driven quality monitoring including human-in-the-loop governance.
Partner with Technology and AI teams to refine scoring models evaluation logic and data feedback loops.
Establish controls to ensure AI-driven scoring maintains compliance rigor and audit defensibility.
Evaluate emerging capabilities (e.g. real-time guidance next-best-action support) for potential impact on quality and partner with Operations leadership on strategy and roadmap.
Drive value realization adoption metrics and operational impact measurement of AI-enabled quality tools.
Analyze recurring scoring patterns to identify systemic process platform training or design signals for improvement opportunity.
Build structured escalation and improvement pathways that feed into broader process excellence initiatives.
Lead targeted continuous improvement initiatives where quality data indicates systemic risk or opportunity.
Develop dashboards and executive-ready reporting that translate quality metrics into operational insights and strategic decisions.
Partner cross-functionally to drive durable process redesign.
Lead mentor and develop a team of quality professionals and analysts.
Foster a culture of accountability objectivity continuous improvement and operational excellence.
Define role clarity performance expectations and capability development pathways.
Ensure appropriate resourcing models across onshore and offshore quality monitoring needs.
Build scalable governance processes that support business growth without linear headcount expansion.
What Youll Bring to Zelis:
o Bachelors degree with 15 years of relevant experience or Masters degree with 10 years.
o 8 years of progressive leadership experience managing multi-level teams in operations or quality environments.
o Expertise in contact center quality assurance and compliance-based scoring frameworks.
o Demonstrated experience building or governing independent audit or quality oversight functions.
o Strong background in continuous improvement methodologies (Lean Six Sigma Black Belt or Master Black Belt strongly preferred).
o Experience translating operational data into enterprise-level improvement initiatives.
o Proven ability to influence cross-functional leaders and drive alignment without direct authority.
o Experience partnering with Technology teams on AI-enabled or automation-driven solutions.
o Proficiency using AI tools skillfully with an understanding of how to develop intelligent prompts and/or agents.
o Strong executive communication skills with the ability to present insights clearly to senior leadership.
o Experience operating in regulated healthcare payer or financial environments strongly preferred.
Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.
Location and Workplace Flexibility
We have offices in Atlanta GA Boston MA Morristown NJ Plano TX St. Louis MO St. Petersburg FL and Hyderabad India. We foster a hybrid and remote friendly culture and all our employees work locations are based on the needs of the position and determined by the Leadership -office work and activities if applicable vary based on the work and team objectives in accordance with Company policies.
Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.
We welcome applicants from all backgrounds and encourage you to apply even if you dont meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.
Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process please email .
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities duties and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities duties and skills from time to time.
Required Experience:
Director
Key Skills
About Company
Discover the connected platform that's bridging gaps and aligning interests of healthcare payers, providers, and healthcare consumers.
