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12/12 Reena Gonsalves
Consultant at Innoquest Consulting

Views:313 Applications:69 Rec. Actions:Recruiter Actions:13

General Manager - Claims Operations - Healthcare Payer (16-20 yrs)

Bangalore Job Code: 1192143

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.

Women-friendly workplace:

Maternity and Paternity Benefits

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