Assistant Vice President - Claims Operations - US Healthcare

Description:

About the Role:

One of our clients is hiring an accomplished AVP Claims Operations (US Healthcare) to lead and transform large-scale claims operations, drive service excellence, and shape the next phase of

In this role, you will spearhead multi-location delivery, partner with global stakeholders, champion RPA & analytics-led transformation, and manage a portfolio of USD 1020M. This is a strategic leadership position reporting to the SVP & Head Payer & Provider Operations.

Key Responsibilities:

Strategic & Operational Leadership

- Lead and scale US Healthcare Claims Operations to gold-standard benchmarks.

- Manage end-to-end claim operations across PI, SIU, Rework, Enrollment, Coding, Product Build & more.

- Drive transformation through RPA, automation, analytics & process improvement initiatives.

- Oversee P&L, budgets, revenue, cost optimization and resource planning.

Client & Stakeholder Management

- Act as the face of the organization for key client engagements, QBR/MBR reviews.

- Provide strategic insights, propose solutions, and ensure top-tier service delivery outcomes.

People Leadership

- Lead a span of 800+ FTE across locations.

- Drive talent development, succession planning, performance management & engagement.

Governance & Compliance

- Ensure adherence to HIPAA, ISO & regulatory requirements.

- Own SLAs, quality metrics, audits & operations governance.

What Were Looking For:

- 18-20+ years in Healthcare BPM with 10-12+ years in US Healthcare Claims Operations.

- Proven experience managing large teams (800+ FTE) and multimillion-dollar portfolios.

- Strong command of payer operations, back-office claims lifecycle & healthcare domain nuances.

- Visionary leadership with expertise in building innovative service delivery models.

- Excellent client management, communication, and cross-functional collaboration skills.