SME Ops

Profile: SME Ops

Experience: 4 Yrs of experience in US Healthcare claims adjudication

Skills Required:

Subject Matter Expert (SME) Operations for US healthcare claims adjudication. The SME will act as the process authority, supporting operations teams in handling complex claim scenarios, resolving escalations, and ensuring process adherence. This role involves mentoring team members, driving operational excellence, and partnering with stakeholders to deliver high-quality results in compliance with client and regulatory requirements.

Education Qualification: Any Graduate

Location: Bangalore

Roles & Responsibilities:

• Provide day-to-day leadership, coaching and development support to direct reports (Sr. Process Consultants).
• Review operating statistics regularly to ensure Client and Organization goals are being met in areas of service quality and timeliness. Typical areas of focus include: quality monitoring scores/daily work assignments, customer satisfaction, account notations, call handle times(If the process has voice requirement), abandon rates and service levels/ line adherence.
• Identify areas of process improvement and work effectively within the organization to implement resolutions on a timely basis. Areas for improvement should be targeted at increasing client satisfaction and/or company profitability.
• Oversee necessary enhancements to client programs or servicing therein. This may include areas such as staffing, training, attendance and quality.
• Responsible for process quality for all work performed by the team.
• Participate in client visits and roundtables to provide inputs on program performance or new programs being offered.
• Coordinate with Manager Operations to balance needs of individual teams with needs of the entire organization.
• Provide growth development opportunities.
• Promote teamwork and cooperative effort.
• Help train and provide guidance to Sr. Process Consultant, other Supervisors and Sr. Supervisors within the organization.
• Maintain a clean, safe, unobstructed work area and practice good safety habits.
• Provide internal and external customers with the highest quality service.
• Familiarize with HIPAA regulations

Mandatory Skills:

• Exceptional interpersonal, customer service, problem-solving, verbal and written communication, and conflict resolution skills.
• Proficiency with the necessary technology, including computers, software applications, phone systems, etc.
• Ability to understand basic data and take appropriate action.
• Ability to drive individual and teams efficiency and productivity through effective and efficient metric management.
• Ability to coach, train, and motivate employees and evaluate their performance.
• Ability to strategically lead and develop team towards improved performance.
• Ability to delegate and manage work loads and projects across functions within the organization.
• Ability to successfully drive continuous improvement efforts by leading various work streams related to call center metrics and monitoring tools.
• Ability to problem solve, handle conflict, anticipate issues/concerns, troubleshoot problems, and proactively institute creative solutions.
• Advanced customer focus and customer service skills

Preferred Skills:

• Basic financial analysis (cost-effectiveness, cost-benefit etc.)

For interview details & scheduling:

Vinodhini –

Job Types: Full-time, Permanent

Pay: ₹450, ₹670,000.00 per year

Benefits:

• Health insurance
• Leave encashment
• Life insurance
• Paid sick time
• Paid time off
• Provident Fund

Ability to commute/relocate:

• Bangalore, Karnataka: Reliably commute or planning to relocate before starting work (Preferred)

Education:

• Bachelor's (Preferred)

Experience:

• US Healthcare claims adjudication: 4 years (Preferred)

Location:

• Bangalore, Karnataka (Preferred)

Work Location: In person

Application Deadline: 19/09/2025

Expected Start Date: 22/09/2025