Associate Director - Claims Adjudication - US Healthcare Payer Operations

Innoquest is looking for a dynamic leader in Claims Adjudication operations for a reputed BPM in the healthcare space.

Mandatory Ask :- Ideal candidature would be 10-14 YEARS OVERALL EXPERIENCE WITH MIN 7+ YEARS IN US HEALTHCARE PAYER OPERATIONS. And experience in Grievances & Appeals,Claims Adjudication is preferred and added advantage.

Should be open to Night shifts.

Roles and Responsibility:-

As a Strategic Thinker:-

- Identifying Transformational Value Creation via RPA and Analytics offerings.

- Value additions and Process Improvement Initiatives.

- Account Management

- Program/ Business Budget and Supply Planning

- Exposure to Cost Optimization controls, budgeting and Improvements.

- Service Quality Management

- Client Communications Management

- Provide strategic direction to assigned lines of businesses

- Take leadership role in migration to new case management database.

- Stakeholder Management

- Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS)

As Driving Results:-

- Track program performance and its impact on the financial goal

- Creating Growth Path/Succession Planning for the process

- Effective Resource Utilization

- Define and review KRA of Manager/Senior Manager

- Identify and participate in training / developmental programs.

- SLA & Metrics Management

- Responsible for monthly/quarterly/annual performance appraisals of employees in the vertical.

- Support development of program policies, rules, protocols, handbooks, and forms for all program components

- Identify opportunities to streamline business processes and systems.

- Represent the company and actively participate in operational reviews, MBR s/QBRs

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards

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

- Attend to Process Escalation and provide effective solutions

- Responsible for Balance Score Card and its parameters

- Attend to Client calls, Stat us Meeting and Client Feedback.

- Review and Regulate SOP

- Can identify problems and take decisions independently

- Provides solutions to individual and organizational challenges