Director - Operations

Director - Operations

Job Title Director Claims Operations – US1 Reporting to Senior Director/AVP Location Bangalore Working Hours/ Days 9 Hours / 5 Days a Week Shift Night Shift (4pm-1am) 9hr shift (There can be fortnightly/ monthly call between 06:30am-2pm IST)
Team Size 300 FTE+ Company URL www.sagilityhealth.com
Mandatory: Ideal candidature would be 14-18 YEARS OVERALL EXPERIENCE WITH MIN 10+ YEARS IN US HEALTHCARE PAYER OPERATIONS.
Desired skills and qualification
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 A Bachelor degree or equivalent qualification.
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 RPA/ Analytics Certification preferred
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 Preferably Lean/ Six Sigma Certified
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 Ideal candidature would be 14-18 YEARS OVERALL EXPERIENCE WITH MIN 7- 10 YEARS IN US healthcare Payer Operations.
As a Strategic Thinker:
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 Identifying Transformational Value Creation via RPA and Analytics offerings.
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 Value additions and Process Improvement Initiatives.
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 Account Management
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 Program/ Business Budget and Supply Planning
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 P&L Management (Revenue management, Cost Optimization, Improvements)
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 Service Quality Management
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 Client Communications Management
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 Provide strategic direction to assigned lines of businesses
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 Take leadership role in migration to new case management database.
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 Stakeholder Management
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 Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS)
As Driving Results:
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 Track program performance and its impact on the financial goal
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 Creating Growth Path/Succession Planning for the process
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 Effective Resource Utilization
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 Define and review KRA of Deputy Manager, Manager, Senior Manager, AGM
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 Identify and participate in training / developmental programs.
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 SLA & Metrics Management
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 Responsible for monthly/quarterly/annual performance appraisals of employees in the vertical.
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 Support development of program policies, rules, protocols, handbooks, and forms for all program components
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 Identify opportunities to streamline business processes and systems.
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 Represent the company and actively participate in operational reviews, MBR s/QBRs
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 Timely reporting of deliverables like Performance Incentive, Internal Dashboards
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 Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.
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 Attend to Process Escalation and provide effective solutions
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 Responsible for Balance Score Card and its parameters
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 Attend to Client calls, Stat us Meeting and Client Feedback.
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 Review and Regulate SOP
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 Can identify problems and take decisions independently
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 Provides solutions to individual and organizational challenges
As a Partner with Clients:
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 Delivering Highest Level of Service Delivery Standards
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 Exemplify Passion for excellence.
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 Design and Drive Business/Program Excellence Initiatives
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 Voice of the Organisation.
Lead People:
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 Inspirational Leadership
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 Lead from the front as the SME of the Business/ Program
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 Design & Drive People Metrics
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 Promoting Diversity & Inclusion as per Organisational Culture
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 Mentoring & Coaching Operational & Leadership values
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 Improve employee retention and enhance employee engagement.
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 Succession Planning
Primary Skills:
 Must be working with U.S based Business / Customers in U.S Shifts
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 Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS)
 Minimum 10+ years of work experience in end to end Claims Adjudication domain
 Business Excellence/ Improvements Projects
 Managed a large and Complex Delivery Team
 Minimum Span Management should be 300+ FTE.
 Client & Stakeholder Management
 P&L Management
Secondary Skills:
 Preferable Onshore Transition experience
 Coaching and Mentoring
 Excellent Communication Skills
 Excellent Analytical skills
 Excellent People Management
 Excellent Presentation Skills

BangaloreIndia