Consultant at Innoquest Consulting
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General Manager - Claims Operations - Healthcare Payer (16-20 yrs)
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.
- 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.