Operations Manager for Healthcare Enrollment

1 day ago

Coimbatore, Tamil Nadu, India beBeeHealthcare Full time ₹ 15,00,000 - ₹ 28,00,000
Team Leader Operations for Enrollment Process

We are seeking an experienced Team Leader to oversee the enrollment and claims adjudication process in our organization.

  • Lead a team of professionals 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.

The ideal candidate will have a strong background in US healthcare operations, with 5-6 years of experience and 1-2 years in a team leadership role. They will be responsible for ensuring efficient workflow, team performance, process improvement, and client satisfaction.

Key Responsibilities:

  • 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.
  • 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 5-6 years of experience in US healthcare processes, with 1-2 years in a team leadership role.
  • SME'S and Quality analysts are eligible to apply.

Benefits:

  • Pick up and drop would be provided.

Role Details:

  • Role: Team Leader
  • Industry Type: BPM / BPO
  • Department: Customer Success, Service & Operations
  • Employment Type: Full Time, Permanent
  • Role Category: Operations

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