Job Description

Responsibilities

• In-depth Knowledge and Experience in the US Health Care Payer System.
• 2-3 years of experience in Claims Adjudication. With over 1 year of experience as a supervisor.
• Proven track record in managing processes, streamlining workflows and excellent people management skills.
• Need to be a people centric manager who could articulate the employee challenges to the management as well as motivate the team towards desired project goals.
• Circulate quality dashboards at agreed periodic intervals to all relevant stake holders
• Adhering to various regulatory and compliance practices.
• Maintaining and Ownership of reports both internal as well as for the clients.
• Presenting the data and provide deep insights about the process to the Clients as well as Internal Management.
• Managing and co- ordinating training programs.
• Excellent in Coaching and providing feedback to the team. Take necessary HR actions as part of the Performance Improvement Process.

Key Performance Indicators

• Ensuring that the key Service Level Agreements are met consistently without any exceptions.
• Leverage all Operational metrices to ensure that the Revenue and Profitability targets are met and exceeded.

• Work in tandem with all Business functions to ensure smooth business process.
• Retention of key team members.

Reporting Structure

• Team Executive -Manager Operations - AD Operations

Qualifications

Qualification & Experience

Critical: Any Degree (Pass/Fail)

• Graduation is a must in any stream of Education

Desirable:

• Post graduation in any stream

Know How

Critical:

• Indepth Process knowledge in Claims Processing
• Front ending the client in a must
• Focus on continuous process improvement

Desirable:

• Six Sigma certified
• Certification in any RPA tool
• Knowledge on AI and ML

Personal Attributes/Traits

• Consultative
• Socially confident
• Achievement oriented
• Decisive and action oriented
• Creative
• Eager to learn
• Resilient

Competencies

• Business Foresight

• Influencing Others

• Fostering Partnerships With Customers

• Managing Transformation

• Driving Excellence

• Leading Teams

• Working Across Boundaries