Discipline - Claims

Industry - Claim Operations

Job Description - Job Description

Primary responsibilities include:

- Lead multifunctional Team of- 250-400 FTE spread across multiple OGS Locations independently with minimal support from the Leadership

- Leads teams that have Health Claims Operations responsibilities including managing upstream and downstream Business stakeholder priorities, investigating delays and bottlenecks in TAT, rework and service Issues, reviewing current achievement on Service Readiness etc.

- Knowledge of P&L management including various levers to optimize margins and ensure minimal revenue Leakage. Having knowledge of Forecasts and the Budgeting process

- Domain expert for the Claims & Non Claims Operations representing OGS in External Opportunities and providing thought Leadership

- Uses appropriate control mechanisms to monitor and manage multiple teams and serves as contact point for OGS Leadership and Onshore stakeholders.

- Ensures execution and high level of delivery on all projects related to Automation, Innovation and Operational Excellence etc.

- Fosters and collaborates with all internal and external customers to ensure customer satisfaction.

- Builds and reviews business scorecards and performance metrics for the assigned teams and appropriately builds action plans.

- Partners with the Senior Leadership in planning, implementation and evaluation / modification of existing operations, systems and procedures.

- Drives teams to maximize performance while maintaining high standards of quality & ensure the organization meets Service Level Agreements / Performance Guarantee goals.

- Oversees, and may directly lead, quality and process improvement initiatives-

- Establishes and maintains an environment conducive of positive morale, creativity and team work and partners in the formulation of career progression / employee development plans

- Hiring, coaching, mentoring and performance management of staff to ensure talent is working toward improving our business and servicing our customers

- Collaborates with Human Capital to develop and implement retention strategies and champion the People Engagement practices

- Manage the peak staffing requirements working with the vendor management Teams ensuring readiness

- Experience in new project migrations and overseeing planning and implementation to ensure the project moves to steady state without hickups

Competencies

- Exceptional ability to drive results through strong collaborating and influencing skills across multiple teams that include widely varied skill sets

- Effective People manager with high emotional intelligence-

- Strong verbal and written communication skills

- Ability to travel domestically and internationally

- Demonstrated ability to work in an ambiguous environment and flexible to change and re-direct as business needs change with high Ownership of the Deliverables

- Strong operational knowledge and ability to understand operational metrics and solve operational and business problems

- Proven organizational skills with ability to be flexible and work effectively in a matrixed environment

- Ability to analyze data and cull out the inferences for effective decision making

- Ability to act pro-actively, with effective communication to Internal & external partners

- Avoid element of Surprise in the business

No. of Openings - 1

Qualification - Qualification & Eligibility

- Bachelors Degree

- 5+ years managing a claims analysis or healthcare operations team preferred

- Ability to work in evening shift and parallel the US working hours

- Good communication skills

Preferred Skills-

- Experience in Provider side of the business

- Any project Management experience- AHM 250 Certification

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