Job Description & How to Apply Below
Repricing & Extended Functions – Strategic Team
Role Type:
Manager (Operations & Transformation)
Role Overview
We are looking for an experienced and highly driven Operations Manager with strong expertise in US Healthcare Claims Adjudication, Over payments, Implementations, Automation, and Strategic Operations Management. The role involves leading end‑to‑end operational strategy, building scalable frameworks, driving automation initiatives, managing cross‑functional stakeholders, and ensuring operational excellence across all programs.
This role requires someone who can think strategically, execute operationally, and lead teams with high ownership and accountability.
Key Responsibilities
1. Strategic Operations & Framework Development
Design, standardize, and implement strategic frameworks for Repricing & Extended Functions.
Build SOPs, workflows, controls, governance structures, and performance models across clients.
Identify gaps and drive continuous improvements for quality, TAT compliance, and operational efficiency.
2. U.S. Healthcare Claims Expertise
Deep understanding of Prepay/Postpay audits, Claims Adjudication, Over payments, Appeals/Disputes, Pricing methodologies, CMS regulations, and payer-specific guidelines.
Provide SME support during escalations, audits, operational reviews, and client interactions.
3. Automation & Process Optimization
Collaborate with Technology, MIS, and Product teams to:
Lead automation initiatives
Build dashboards, trackers, and validation frameworks
Drive digital solutions for high‑volume manual processes
4. Implementation & Transition Management
Lead client onboarding, program transitions, and workflow implementation.
Prepare process maps, requirement documents, and testing scenarios (UAT & Production readiness).
Ensure smooth knowledge transfer and process stabilization.
5. Team Leadership & Resource Management
Manage team performance, goal setting, resource utilization, and cross‑training.
Mentor team members and foster a high‑performing culture.
Ensure clarity of roles, responsibilities, and expectations across functions.
6. Stakeholder Management
Act as the primary contact for Operations, Clinical, Coding, MIS, Technology, and Client.
Collaborate effectively with senior leadership and provide meaningful insights, governance updates, and status reporting.
7. Reporting & Governance
Prepare executive dashboards, RCA reports, operational insights, and compliance updates.
Drive governance meetings, reviews, and performance improvement initiatives.
Required Skills & Experience
7–12 years of experience in US Healthcare Operations, specifically Claims, Pricing, or Over payments.
Proven experience in operations management, automation, client communication, and process transitions.
Hands‑on knowledge of pricing tools
Experience in workflow platform testing (UAT), scenario creation, and reporting defects.
Strong analytical skills and proficiency in MS Excel, PowerPoint, and process documentation.
Prior experience in handling teams of 10 - 30 FTEs.
Must be based in Chennai and available to work from office frequently for team interactions, discussions, leadership meetings, and to ensure seamless client delivery.
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