AGM - Operations - Claims - BPO

Experience: 10 to 14 years overall, 5 to 7 years in Claims a must

Shift Timings: 4pm to 1 AM

HeadCount / FTEs/ SPAN : 500+

Required Domain Skills:

- Experience in Payment Integrity / Payment Recovery/ Cost Containment - Desirable

- Experience in Claims Adjucation/ Processing for at least 10+ years

- Experience in Pre-Authorization and Post Authorization - Desirable

- Experience in Planned Services (Plan Setup/ Plan Testing)- Desirable

- Experience in Denial Management -Desirable

- US health care (ERISA/HIPAA/State Mandates)

- Minimum 10+ years of work experience in Claims Adjudication domain

- Experience in any Mailroom process (US Healthcare mailroom would be Desirable)

Operational Skills:

- Willing to work in flexible shifts (Mid shift)

- Minimum Span Management should be 350+ FTE

- Client Management

- P&L Management

- Awareness of Statutory Compliances like ISO, ISMS

- Managed a large and Complex Delivery Team

- Preferable Onshore Transition experience

- Business Excellence/ Improvements Projects

- Stakeholder Management

Intrapersonal Skills:

- Excellent Communication Skills

- Excellent Analytical skills

- Excellent People Management

- Excellent Presentation Skills

- Stakeholder Management

- Coaching and Mentoring

Educational Skills:

- Graduation/Post Graduation Must

- Lean/Six Sigma Certification is must

- RPA/ Analytics Certification preferred