
Healthcare Operations Director
2 weeks ago
Senior Manager Healthcare Operations
Job Description:
The Senior Manager will lead a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, client-specific guidelines, and quality standards. The role ensures efficient workflow, team performance, process improvement, and client satisfaction.
Key responsibilities include:
- 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.
The Senior Manager will oversee new member enrollment, renewals, terminations, and updates in healthcare plans. This includes ensuring data accuracy for member eligibility, coverage, and benefits. Collaboration with clients and internal teams is also essential to resolve enrollment discrepancies or queries.
Claims Adjudication Oversight:The Senior Manager will supervise the processing of healthcare claims, ensuring accuracy and compliance with policies, provider contracts, and regulatory guidelines (HIPAA, CMS, etc.). Proper review of claims for eligibility, benefits coverage, coding, and payments is critical.
Process & Compliance:The Senior Manager must ensure compliance with US healthcare regulations, privacy laws (HIPAA), and client-specific guidelines. Process improvement opportunities are identified and implemented in collaboration with quality teams.
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