Operations Director Healthcare Enrollment

1 day ago

Coimbatore, Tamil Nadu, India beBeeHealthcare Full time ₹ 1,50,000 - ₹ 28,00,000

Senior Management Role in Enrollment and Claims Processing

We are seeking an experienced Senior Manager to oversee a team of healthcare professionals responsible for processing member enrollments and adjudicating claims in compliance with US healthcare regulations, quality standards, and client guidelines.

The role involves efficient workflow management, team performance, process improvement, and client satisfaction. The ideal candidate will have strong leadership skills, experience in enrollment and claims processes, and knowledge of US healthcare insurance rules.

Key Responsibilities:

  • 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.

Required Skills and Qualifications:

  • Bachelor's degree or equivalent work experience in healthcare operations.
  • Minimum: 10+ years of experience in US healthcare processes, with 3 years in a senior manager role in enrollment and claims, EDI or provider contracting.
  • Strong knowledge of US healthcare insurance, including enrollment, eligibility, claims processing, and adjudication rules.

Benefits:

  • Full-time, permanent employment opportunity.
  • Competitive salary and benefits package.

Others:

  • Interest candidates can share their updated CV for consideration.
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