Operational Performance & Governance Lead

Role Purpose

The Operational Performance & Governance Lead is responsible for maintaining the overall health and stability of day-to-day operations through proactive monitoring, risk identification, and cross-functional coordination. Acting as the operational control tower for the business, this role provides real-time visibility of service performance across all operational areas.

The role partners closely with the META Lead and operational leaders to ensure key service metrics remain within target, operational risks are identified early, and corrective actions are driven to resolution before customer, client, or SLA impact occurs. Through disciplined operational governance, performance reporting, and stakeholder engagement, this role enables a proactive and data-driven approach to managing service delivery across the business.

Key Accountabilities

• Operational Health Monitoring & Governance

• Serve as the central point of coordination for operational health monitoring across all functions.
• Maintain real-time oversight of key operational metrics including:
  • Claims Inventory
  • Call queues
  • Email inventories
  • Pend volumes
  • SLA adherence
  • Turnaround time performance inclusive all interdependent team. E.g. Client Services, Clinical, Member Investigation Units, Provider etc.
• Identify emerging operational risks, bottlenecks, workload imbalances, and capacity constraints.
• Escalate risks and recommend mitigation actions before service levels are impacted.
• Partner with operational leaders to maintain overall operational stability.

Real-Time Performance Management (RTFM)

• Perform real-time operational monitoring and workforce performance tracking.
• Continuously monitor service levels against agreed operational targets and client commitments.
• Maintain dashboards and operational scorecards to provide visibility of performance trends.
• Conduct intraday reviews to identify potential SLA or backlog risks.
• Alert leaders and operational teams when performance thresholds are at risk.
• Support short-term workload balancing activities to optimize operational capacity.

Risk Identification & Escalation Management

• Proactively identify high-risk cases, aging inventories, complex customer issues, and service recovery requirements.
• Monitor potential escalations through operational dashboards, complaints, and service trend analysis.
• Coordinate intervention activities with operational, clinical, product, technology, and client service teams.
• Ensure timely escalation of risks requiring leadership attention.
• Maintain governance over action plans until resolution is achieved.

Cross-Functional Issue Resolution

• Lead coordination activities across departments to address service delivery challenges.
• Facilitate timely resolution of operational issues impacting customer experience, productivity, or SLA performance.
• Drive accountability across teams for agreed corrective actions.
• Partner with Claims, Authorizations, Client Services, Communications, Clinical Operations, Product, and Technology teams to resolve operational gaps.
• Support incident management activities during business disruptions or system outages.

Operational Reporting & Insights

• Develop and distribute daily, weekly, and ad-hoc operational health reports.
• Provide regular updates to leadership on:
  • Service performance
  • Key risks
  • Backlog health
  • Capacity concerns
  • Escalation trends
  • SLA performance
• Translate operational data into actionable recommendations.
• Highlight recurring issues, root causes, and opportunities for improvement.
• Present performance insights during operational governance meetings.

Service Continuity & Incident Coordination

• Act as a coordination point during operational incidents, system outages, or business disruptions.
• Partner with Technology and business teams to understand operational impact and recovery plans.
• Monitor operational recovery activities and service restoration progress.
• Ensure stakeholders remain informed of business risks and mitigation actions.
• Support business continuity and contingency planning activities.

Continuous Improvement & Operational Excellence

• Identify recurring operational issues and drive root cause analysis activities.
• Recommend process improvements to strengthen operational resilience and reduce service risk.
• Support automation opportunities through improved monitoring, reporting, and exception management.
• Contribute to initiatives focused on improving productivity, efficiency, service quality, and customer experience.
• Champion a proactive risk-management culture across operational teams.

Stakeholder Management

• Internal Stakeholders

• META Lead
• Claims Leadership
• Client Services Leadership
• Communications Leadership
• Clinical Operations
• Product Teams
• Technology & IT Teams
• Workforce Management
• Quality & Training Teams

External Stakeholders

• Clients (when operational incidents require visibility)
• Strategic vendor partners (where applicable)

Success Measures

Service Performance

• SLA attainment consistently maintained within target
• Reduction in aged inventory and backlog risk
• Reduction in avoidable service escalations

Risk Management

• Early identification of operational risks
• Reduction in customer-impacting incidents
• Timely mitigation and resolution of operational issues

Governance & Reporting

• Timely operational health reporting
• Accurate risk visibility across leadership teams
• Effective escalation and action tracking

Cross-Functional Collaboration

• Resolution of operational issues within agreed timelines
• Strong stakeholder engagement across business functions
• Improved accountability and follow-through on corrective actions

Continuous Improvement

• Measurable reduction in recurring operational gaps
• Improved operational efficiency and service stability
• Increased automation and proactive monitoring capabilities

About The Cigna Group