AGM - Payer Operations - BPO

Objectives and Responsibilities of AGMOperations:

(A) As a Strategic Thinker:

- Identifying Transformational Value Creation via RPA and Analytics offerings.

- Value additions and Process Improvement Initiatives.

- Account Management

- Program/ Business Budget and Supply Planning

- P&L Management (Revenue management, Cost Optimization, Improvements)

- Service Quality Management

- Client Communications Management

- 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)

(B) As Driving Results:

- Track program performance and its impact on the financial goals

- Creating Growth Path/Succession Planning for the process

- Effective Resource Utilization

- Define and review KRA of Deputy Manager, Manager, Senior Manager .

- 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, MBRs/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

(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

- 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

Mandatory Skills & Qualifications:

Domain Skills:

- Experience in Payment Integrity / Payment Recovery/ Cost Containment - Desirable

- Experience in Claims Adjucation/ Processing for at least 10+ years

- Experience in Pre-Authorisation and Post Authorisation - Desirable

- Experience in Planned Services (Plan Setup/ Plan Testing)- Desirable

- Experience in Denial Management -Desirable

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

- Minimum 10+ years of work experience in Claims Adjudication domain

- Experience in any Mailroom process (US Healthcare mailroom would be Desirable)

Operational Skills:

- Willing to work in flexible shifts (Mid shift)

- Minimum Span Management should be 350+ FTE

- Client Management

- P&L Management

- Awareness of Statutory Compliances like ISO, ISMS

- Managed a large and Complex Delivery Team

- Preferable Onshore Transition experience

- Business Excellence/ Improvements Projects

- Stakeholder Management

Educational Skills:

- Graduation/Post Graduation Must

- Lean/Six Sigma Certification is must

- RPA/ Analytics Certification preferred