Claims Management Executive

1 week ago


Hyderabad, Telangana, India People Impact Full time

Claims Management Executive

We are seeking an experienced Claims Management Executive to join our team at People Impact. In this role, you will be responsible for driving strategic guidance for payer operations.

The key responsibilities include:

  • Strategic Guidance

- Drive strategy for payer operations, focusing on claims, member engagement, provider relationships, and cost management.

- Implement innovative solutions using AI, automation, and analytics to optimize processes.

- Stay abreast of industry trends and regulatory updates (e.g., CMS, ACA) to align strategies.

Enablement of Technology

- Collaborate with tech teams to deploy advanced platforms for claims adjudication, payment integrity, and member engagement.

- Utilize predictive analytics to enhance risk management and optimize value-based payment models.

- Ensure compliance and interoperability with standards like HIPAA, FHIR, and EDI.

Leadership

- Build and lead high-performing, cross-functional teams, fostering collaboration and accountability.

- Champion a culture of innovation and continuous improvement while mentoring team members.

Collaboration Among Stakeholders

- Partner with providers, employers, and regulatory agencies to strengthen relationships and drive service excellence.

- Align payer strategies with population health and care delivery initiatives.

Financial Supervision

- Manage budgets to ensure cost-efficiency and ROI while identifying opportunities to reduce MLR and enhance profitability.

The ideal candidate should have:

  • 25+ years of healthcare payer experience.
  • Expertise in claims management, value-based payments, and regulatory compliance (CMS, HIPAA).
  • Proficiency with payer tech platforms, analytics, and CRM tools.
  • Exceptional strategic, problem-solving, and executive communication skills.

Estimated salary: $230,000 - $280,000 per year.



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