Assistant Vice President - Claims/Payer Operations - Healthcare BPM Industry

We are currently hiring an AVP - Claims/Payer Operations for one of our clients, a US-based Healthcare BPM. This role offers the opportunity to lead high-impact claims operations while contributing to the growth and success of a global organization.

MANDATORY ASK:

18-20+ YEARS' OVERALL EXPERIENCE WITH MINIMUM 10-12 YEARS IN US HEALTHCARE CLAIMS OPERATIONS / OPEN TO WORKING NIGHT SHIFTS

OBJECTIVES OF THE ROLE FOR AVP CLAIMS OPERATIONS:

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 goal from the Claims Operations perspective.

- Creating Growth Path/Succession Planning for the process.

- Effective Resource Utilization.

- Define and review KRA of Manager/Senior Manager/AGM/DGM/GM.

- 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, Stat us 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. LEADING PEOPLE:

- Inspirational Leadership.

- Lead from the front as the SME of the Business/ Program.

- Design & Drive People Metrics.

- Promoting Diversity & Inclusion as per Organizational Culture.

- Mentoring & Coaching Operational & Leadership values.

- Improve employee retention and enhance employee engagement.

- Succession Planning.

E. COLLABORATION:

- Plays a highly collaborative role, building solid cross-functional relationships with departmental heads and management across the business spectrum.

- Partners with other operations, clients, L&D and HR function to determine program priorities, roll-out plans, set program deadlines, ROI and analytics.

- Collaborates with departmental heads and managers, to identify areas that require training and to develop program requirements unique to each department. Ability to work closely with key stakeholders in addressing gaps in the overall Solution designs.

F. REPORTING & ANALYTICS:

- Plays an analytical role conducting current and ongoing strategic assessments of business-wide training and development programs and initiatives.

- Ensure effective data governance, reporting and measures program delivery quality, which ensures continuous improvement, maintenance, and adjustment in Solutions delivery.

G. KNOWLEDGE:

- Guide stakeholders, both internal and external, on the path to the solution while driving executive sign-off.

- Prepare spend estimates, work plans and identify delivery locations while gaining input and buy-in from the legal, finance and delivery teams on approach, solution plan and cost to deliver.

- Expertise in different pricing models like PMPM, outcome based, transaction and FTE.

EXPERIENCE & COMPETENCIES EXPECTED FROM THE ROLE:

- 18-20+ years of overall experience as a Strong and capable leader that is self-motivated and driven to win the confidence and trust of her/his prospects, clients, global operations, and pursuit teams alike - establishing winning strategies, and exerting influence both internally and externally to win new business.

- Innovative team player with the energy, creativity, and an entrepreneurial spirit to achieve success. A professional who earns respect for his/her leadership, intelligence, and expertise.

- Success as a superb relationship builder, negotiator, and communicator.

- 10-12+ years' experience in U.S healthcare BPO operations/solutions and preferably from the Payor operations background.

- Possess commercial acumen, drive commercial impact (sales, cost reduction projects)

- Acts as a Subject Matter Expert for the sales and client services teams, attends sales calls, demonstrates the products, helps to answer deep questions about the product and works to convince the client we have the best solution.

- Lead and front-end projects (internal - with Ops/IT/BE, external - selling and supporting sales) and lead work through influence to manage stakeholders (internal matrix, client, partner)

- Strong communicator who can take complex ideas and communicate them effectively internally, externally and using Project Management tools

- Strong and capable leader that is self-motivated and driven to win the confidence and trust of her/his peers, clients, global operations, and pursuit teams alike - establishing winning strategies, and exerting influence both internally and externally to win new business.

- Innovative team player with the energy, creativity, and an entrepreneurial spirit to achieve success.

- A professional who earns respect for his/her leadership, intelligence, and expertise.