Senior Manager - Claims Payer Operations - BPO

Objectives and Responsibilities of Senior Manager Claims Payer Operations

(A) As a Strategic Thinker:

- Transition Planning and Coordination

- Identifying Value additions and Process Improvement Initiatives

- Process Metrics review with the senior management and the team

- Identifying, recommending, and implementing ways to increase the productivity and the quality of the team

- Adherence to company policies

- Ensuring the process meets the defined Service Levels

- ISO and HIPAA compliance

(B) As Driving Results:

- Creating Growth Path/Succession Planning for the process

- Effective Resource Utilization

- Define and review KRA of Leads, AMs & DMs & Managers

- Manages day to day Operations

- Timely reporting of deliverables like Performance Incentive, Internal Dashboards

- Responsible for timely invoicing.

- 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

- Identifying problems and take decisions independently

- Provides solutions to individual and organizational challenges

(C) 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.

(D) Lead People

- Managing Self

- 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:

- US health care (ERISA/HIPAA/State Mandates)

- Graduation / Postgraduate / Preferably PMI Certified

- 10 - 12 experience in US Healthcare

- Span of Control should be minimum 150+

- Exposure or Understanding to P&L Management is preferable

- Experience in Claims Adjucation/ Processing for at least with 7+ years in Payer Claims

- Operations Experience in Pre-Authorisation and Post Authorisation

- Experience in RPA & Analytics

- 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