AGM - US Healthcare Payer Operations/Claims Adjudication

This Opportunity is with a reputed client who is a Global Leader in Business Process Management, optimizing the customer experience lifecycle.

Mandatory Ask-

Experience - 12-14 years) AGM role.

years Overall Experience With Min 3-7 years In US Healthcare Payer / Open To Working Night Shifts.

Shift timimgs- 4pm to 1am

Location-Bangalore

Responsibilities-

- Transition Planning and Coordination.

- Identifying Value additions and Process Improvement Initiatives.

- Team management

- Process Metrics review with the senior management and the team.

- Identifying, recommending and implementing ways to increase the productivity and the quality of the team.

- Adherence to company policies.

- Ensuring the process meets the defined Service Levels.

- ISO and HIPAA compliance.

- Creating Growth Path/Succession Planning for the process.

- Effective Resource Utilization.

- Define and review KRA of Leads, AMs & DMs Manages day to day Operations.

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards.

- Responsible for timely invoicing.

- Attend to Process Escalation and provide effective solutions.

- Responsible for Balance Score Card and its parameters.

- Attend to Client calls, Status Meeting and Client Feedback.

- Review and Regulate SOP.

- Is able to identify problems and take decisions independently.

- Provides solutions to individual and organizational challenges.

- Co-ordinate on Process Quality requirements.

- Driving Perfect Service.

- Driving Formula one and other Developmental Programs for the team.

- Identifying, recommending and implementing ways to increase the productivity and the quality of the team.

- Identify and participate in training / developmental programs.

- Control Absenteeism and Attrition in the Process.

- Coaches and mentors AMs & DMs.

- Hiring as per the process requirements.

Key Parameters:

- Graduation / Post Graduate / Preferably PMI Certified

- Minimum 8 years experience in the industry, out of which at-least 2 years experience as a Unit Lead

- Extensive experience in US Healthcare with 4-8 yrs in payer operations

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

- Process SLA.

- Awareness of ISO, ISMS.

- Telephone etiquette.

- MS office.

- Process Knowledge.

- Effective communication.

- Good analytical skills.

- People Management.

- Feedback and Counseling.

- Presentation.

- Coaching and Mentoring