Director - Claims Operations - US Healthcare Payer Operations

Innoquest is looking for an individual with entrepreneur mindset for the position of Director Operations for the Claims LOB in Healthcare.

Mandatory Ask:-Ideal candidature would be 14-18 YEARS OVERALL EXPERIENCE WITH MIN 10+ YEARS IN US HEALTHCARE PAYER OPERATIONS.

Roles & 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

- 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/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 Deputy Manager, Manager, Senior Manager, AGM

- 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