AddressMandatory: Ideal candidature would be 18-24 + YEARS OVERALL EXPERIENCE WITH MIN 14- 16 YEARS IN US HEALTHCARE CLAIMS OPERATIONS in a Senior Service Delivery Leadership Role.
Ideation of the Role
A. Help ideate and reposition the organisation as an innovative U.S Healthcare BPM services Market Leader, through Integrated Service Delivery approach as a Claims Operations VP, to enable champion innovative solutions that drive efficiencies, drive value to make our client organizations more productive and better able to anticipate consumer needs (Increase client preference for the organisation and help build innovative service delivery outcomes and solutions)
B. Design integrated Service Delivery practices and solutions for a mix of traditional administrative services along with cutting edge automation/transformation led solutions at each stage of the consumer journey and standardising service delivery approach across all the geos through Metrics based governance.
C. The role will evolve as the Head for Claims Operations and eventually lead as a Strategic Business Unit within the Payor Operations across the organisation for all geos.
- Ability to design solution that define committed outcomes to the customers
- Collaborate as a key member of the strategic account management team to represent solution offerings from discovery to deal closure, facilitating the transition and implementation to the delivery organization.
D. The ideal candidate is a Thought Leader, accountable for Conceptualizing, Partnering, and Delivering new line of solutions across U.S healthcare domain.
E. A leader who has intense intellectual curiosity about exceeding customer expectations, keenly situationally aware, a selfless team player, relentless in the pursuit of closing large global deals, deep appreciation for global delivery and diversity, and guided by a strong ethical compass.
Vision of the Role
Role Spectrum:
A. Leading Service Delivery Practitioner who can help design and articulate the Claims Operations to the Gold Standard
B. Execute the Vision/Drive the Road Map for Claims Operations
- Works with key stakeholders to execute the long-term vision and develop the roadmap for a differentiated and competitive offering in the marketplace through transformational Service Delivery approach.
- Deep operationalize expertise and ability to manage large operations (+3500 associates)
- Ability to deal with complexity and work in a past pace environment.
- Should be able to collaborate and work with cross geo leaders in connecting the dots and drive customer experience and value.
- Though largely the domain is claims, this delivery Leader needs to have a good understanding of the entire Backoffice claims life cycle- PI, SIU, Rework, Enrolment, Product build, Sales ops, Coding and G&A.
- Championing and lead the RPA and analytics initiatives to ensure end customer value. Should be able to work seamlessly with both internal and customer RPA teams in driving the agenda of customer value creation.
Reporting to SVP & Head of Payor Operations
Objectives and Responsibilities of VP GCO
(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) GCO perspective.
- 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, Stat us Meeting and Client Feedback.
- Review and Regulate SOP
- Can identify problems and take decisions independently
- Provides solutions to individual and organizational challenges
