General Manager - Claims Operations - Healthcare Payer

Job Description

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.,

Keyskills :
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