MANDATORY ASK: 16-20+ YEARS OVERALL EXPERIENCE WITH MIN 12-14 YEARS IN US HEALTHCARE CLAIMS OPERATIONS / OPEN TO WORKING NIGHT SHIFTS AS A STRATEGIC THINKER: - Identifying Transformational Value Creation via RPA and Analytics offerings. - Value additions and Process Improvement Initiatives. - Design Thinker and bringing thought leadership to the Business. - Account Management. - Program/ Business Budget and Supply Planning. - P&L Management (Revenue management, Cost Optimization, Improvements). - Service Quality Management. - Client Communications Management. - Has a Solution Design experience and could help create new line of business with the Service value stream. - 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/AGM/DGM. - 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, Status Meeting and Client Feedback. - Review and Regulate SOP. - Can identify problems and take decisions independently. - Provides solutions to individual and organizational challenges. AS A PARTNER WITH CLIENTS: - Delivering Highest Level of Service Delivery Standards. - Exemplify Passion for excellence. - Design and Drive Business/Program Excellence Initiatives. - Voice of the Organisation. - Ability to enhance the Service Model and design innovative commercial models to drive profitability. LEAD PEOPLE: - Inspirational Leadership. - Lead from the front as the SME of the Business/ Program. - Design & Drive People Metrics. - Promoting Diversity & Inclusion as per Organisational Culture. - Mentoring & Coaching Operational & Leadership values. - Improve employee retention and enhance employee engagement. - Succession Planning. QUALIFICATIONS & MANDATORY SKILLS: - Graduation / Postgraduate / Preferably PMI Certified. - Graduate in B-Pharma/Biotechnology preferred. - 16-20+ years' experience in the industry, out of which at-least 6+ years' experience as a Unit Lead. - Extensive experience in US Healthcare with 12- 14+ years in CLAIMS Operations/Process excellence/operations strategy. - Prior experience in managing end to end Claims lifecycle along with Cost Containment, Benefits Administration, Grievance and Appeals would be preferred. - US health care (ERISA/HIPAA/State Mandates). - Preferably Six Sigma/ Lean Sigma certified. - Proven participation on Improvements Project. - Managed a large and Complex Delivery Team. - Preferable Onshore Transition experience. - Awareness of ISO, ISMS & other Compliance and Audit Parameters. - Astute understanding of MS Office Tools. - Displays a High Level of Integrity and Maturity. - Displays high level of People Management practices.

Bangalore

General Manager - Claims Operations - Healthcare Payer 

General Manager - Claims Operations - Healthcare Payer  ,Job Description for General Manager - Claims Operations - Healthcare Payer  in Innoquest Consulting in  Bangalore for (16-20) years of experience. Apply Now!

Job Description for General Manager - Claims Operations - Healthcare Payer  in Innoquest Consulting in  Bangalore for (16-20) years of experience. Apply Now!