Senior Manager Operations For Enrollment And Claims Management

1 day ago


Coimbatore, Tamil Nadu, India beBeeOperations Full time ₹ 1,04,000 - ₹ 1,30,878

Job Title: Operations Leader - Enrollment and Claims Management

 

The role of the Operations Leader is to oversee the entire lifecycle of member enrollments and claims adjudication, ensuring compliance with US healthcare regulations, client-specific guidelines, and quality standards. This involves managing a team of professionals responsible for processing new enrollments, renewals, terminations, and updates in healthcare plans.

 

Key Responsibilities:

 • Team Management & Leadership:

 Lead, mentor, and manage a team handling enrollment and claims adjudication processes.

 Monitor team productivity, quality, and adherence to service level agreements (SLAs).

 Provide training, coaching, and development opportunities to team members.

 Conduct regular team meetings, performance reviews, and provide constructive feedback.

 Resolve escalations and complex issues promptly and professionally.

 

• Enrollment Management:

 Oversee new member enrollment, renewals, terminations, and updates in healthcare plans.

 Ensure data accuracy for member eligibility, coverage, and benefits.

 Collaborate with clients and internal teams to resolve enrollment discrepancies or queries.

 

• Claims Adjudication Oversight:

 Supervise the processing of healthcare claims ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.).

 Ensure proper review of claims for eligibility, benefits coverage, coding, and payments.

 Monitor claim denials and implement corrective action plans to reduce errors and rework.

 

• Process & Compliance:

 Ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines.

 Identify process improvement opportunities and work with quality teams to implement best practices.

 Prepare and analyze reports related to team performance, quality audits, and operational metrics.

 Liaise with clients and stakeholders for updates, process changes, or reporting needs.

 

• Required Skills and Qualifications:

 Bachelors degree or equivalent work experience in healthcare operations.

 Minimum 10+ years of experience in US healthcare processes, with 3 years in a Operation manager in Enrollment and claims, EDI or provider contracting.

 Strong knowledge of US healthcare insurance, including enrollment, eligibility, claims processing, and adjudication rules.

 Proficient with CMS, Medicaid, Medicare, ACA, and HIPAA regulations.

 Proficient in claims platforms.

 Excellent analytical, problem-solving, and decision-making skills.

 Strong communication and interpersonal skills.

 Ability to multitask and work under pressure.

 

• Benefits:

 Transportation will be provided for employees.

 

• Others:

 If interested in this position, please submit your updated CV.



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