Claims Operations is the back bone of the TPA business. Being able to deliver on the SLA's and constantly innovate to exceed on them is the basic aspect that helps us differentiate our services and has a strong impact on being able to retain existing clients and also acquire new ones.  The role of the Manager Service delivery is to focus on ensuring that the Claims processing is done in accordance with the SLA's and contractual obligations.  Key job responsibilities are as detailed below :   Roles and Responsibilities :  - Head of claims operations for the 3 regions and will have the responsibility to manage the Operations managers who oversee the operations of the respective regions  - Responsible to provide managerial guidance to the region operations managers, head of Registration team etc.  - Forecasting and planning of staffing of the claims operations - Registration, Computation, Adjudication, Document Recovery Team  - Accountable for people engagement across the operations, as a leader is expected to communicate constantly on key people practices and drive the implementation of the same. Eg. Performance management, salary planning, engagement surveys, goal setting  - Facilitate monthly and quarterly reviews of the respective regions with the region heads for their portfolios.  - Will be the point of escalation in case the region heads are unable to address the concerns raised on time.  - Regular review of all open claims region wise and ensuring end to end tracking until the claim is settled.  - Monitor all aspects of the service delivery in accordance with the contractual commitments and SLA commitments to different stakeholders. Needs to ensure that the delivery is done in accordance with the same.  - The role will review networks and finance and define SLA's for their functions which impact claims processing and ensure there is collaboration with the respective function heads.  - The role oversees 3-4 sub functions with inter-linkages and dependencies, thus the individual needs to spend a fair amount of time in reviewing processes, team structure and ensure alignment  - Handling Insurance / Brokers Audits and contesting the same for minimum exposure to the Organisation.  - Manage Insurance Audits and Getting Audit findings to be converted to Trainings to avoid future findings .  Candidate profile :  - Experience of 8-10 years in operations, if in health insurance claims management it will be an added advantage.  - Should have managed team leaders/first level managers  - Strong process and business acumen  - Exposure to managing multiple stakeholders in the past jobs at least for a period of 2-3 years.  - Strong process orientation and training on quality processes - Six Sigma, ISO etc  - Experience in having implemented technology systems in the past as a process owner will be an added advantage

Mumbai

UnitedHealth Group - Manager - Service Delivery - Claims 

UnitedHealth Group - Manager - Service Delivery - Claims  ,Job Description for UnitedHealth Group - Manager - Service Delivery - Claims  in United Health Group in  Mumbai for (8-10) years of experience. Apply Now!

Job Description for UnitedHealth Group - Manager - Service Delivery - Claims  in United Health Group in  Mumbai for (8-10) years of experience. Apply Now!