Associate Director - Operations - Healthcare Claims Adjudication

Description: Innoquest is currently looking for an experienced professional for an Associate Director Operations role for one of its clients in the Healthcare Industry, based in Indore. The ideal candidate should possess strong healthcare industry knowledge and extensive experience in operations management.

Mandatory Ask:

- Should have 7+ years of experience in operations working in US healthcare payer operations and experience in Claims, Membership Enrollment, PDM, Grievances & Appeals is preferred and added advantage.

- Open for Indore location.

- Open for US shifts.

Roles & Responsibility:

- Identifying Transformational Value Creation via RPA and Analytics offerings.

- Value additions and Process Improvement Initiatives.

- Account Management.

- Program/ Business Budget and Supply Planning.

- P&L Management (Revenue management. Cost Optimization, 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/ SO/SMS).

- 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 Deputy Manager, Manager, Senior Manager, AGM.

- Identify and participate in training/ team development programs.

- SLA & Metrics Management.

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

- Support development of program policies rules, protocols handbooks, and form all program protocols.