Job Title: Associate Vice President – (US Healthcare BPO - Payor Claims Operations)
Reporting to: SVP & Head of Payor & Provider Operations
Location:
Working Hours/ Days:
Shift:
Team Size:
Company URL: www.sagilityhealth.com
Summary:
Payor Claims Operations
Ideation of the Role
A. Help ideate and reposition Sagility as an innovative U.S Healthcare BPM services Market Leader, through Integrated Service Delivery approach as a Claims Operations AVP, to enable champion innovative solutions that drive efficiencies, drive value to make our client organizations more productive and better able to anticipate consumer needs (Increase client preference for Sagility and help build innovative service delivery outcomes and solutions)
B. Design integrated Service Delivery practices and solutions for a mix of traditional administrative services along with cutting edge automation/transformation led solutions at each stage of the consumer journey and standardizing service delivery approach across all the geos through Metrics based governance. - The role will report to the Head Claims Operations - Ability to design solution that define committed outcomes to the customers - Collaborate as a key member of the strategic account management team to represent solution offerings from discovery to deal closure, facilitating the transition and implementation to the SAGILITY delivery organization.
C. The ideal candidate is a Thought Leader, accountable for Conceptualizing, Partnering, and Delivering new line of solutions across U.S healthcare domain.
D. A leader who has intense intellectual curiosity about exceeding customer expectations, keenly situationally aware, a selfless team player, relentless in the pursuit of closing large global deals, deep appreciation for global delivery and diversity, and guided by a strong ethical compass.
Vision of the Role
Role Spectrum:
- Leading Service Delivery Practitioner who can help design and articulate the Claims Operations to the Gold Standard
- Execute the Vision/Drive the Road Map for Claims Operations - Works with key stakeholders to execute the long-term vision and develop the roadmap for a differentiated and competitive offering in the marketplace through transformational Service Delivery approach.
- Deep operationalize expertise and ability to manage large operations (+800 associates) with a portfolio size of 10 Million to 20 Million USD business size.
- Ability to deal with complexity and work in a past pace environment. - Should be able to collaborate and work with cross geo leaders in connecting the dots and drive customer experience and value.
- By and large the domain claims, this delivery Leader needs to have a good understanding of the entire Backoffice claims life cycle- PI, SIU, Rework, Enrolment, Product build, Sales ops, Coding and G&A.
- Championing and leading the RPA and analytics initiatives to ensure end customer value. Should be able to work seamlessly with both internal and customer RPA teams in driving the agenda of customer value creation.
Objectives of the Role for Assistant Vice President Payor Claims Operations Operations:
As a Strategic Thinker: -
- Identifying Transformational Value Creation via RPA and Analytics offerings.
- Value additions and Process Improvement Initiatives.
- Account Management - Program/ Business Budget and Supply Planning
- P&L Management (Revenue management, Cost Optimization, Improvements)
Service Quality Management
- Client Communications Management
- Provide strategic direction to assigned lines of businesses
- Take leadership role in migration to new case management database. - Stakeholder Management
- Statutory Audit & Compliance Adherence (HIPAA/ISO/ISMS)
As Driving Results:
- Track program performance and its impact on the financial goal from the Claims Operations perspective.
- Creating Growth Path/Succession Planning for the process - Effective Resource Utilization
- Define and review KRA of Manager/Senior Manager/AGM/DGM/GM
- Identify and participate in training / developmental programs.
- SLA & Metrics Management
- Responsible for monthly/quarterly/annual performance appraisals of employees in the vertical.
- Support development of program policies, rules, protocols, handbooks, and forms for all program components - Identify opportunities to streamline business processes and systems.
- Represent the company and actively participate in operational reviews, MBR s/QBRs
- Timely reporting of deliverables like Performance Incentive, Internal Dashboards - Identifying, recommending, and implementing ways to increase the productivity and the quality of the team.
- Attend to Process Escalation and provide effective solutions
- Responsible for Balance Score Card and its parameters - Attend to Client calls, Stat us Meeting and Client Feedback.
- Review and Regulate SOP
- Can identify problems and take decisions independently - Provides solutions to individual and organizational challenges.
(C) As a Partner with Clients:
- Delivering Highest Level of Service Delivery Standards
- Exemplify Passion for excellence
- Design and Drive Business/Program Excellence Initiatives - Voice of the Organisation.
(D) Leading People:
- Inspirational Leadership
- Lead from the front as the SME of the Business/ Program
- Design & Drive People Metrics
- Promoting Diversity & Inclusion as per Organizational Culture
- Mentoring & Coaching Operational & Leadership values
- Improve employee retention and enhance employee engagement.
- Succession Planning
(E) Collaboration:
- Plays a highly collaborative role, building solid cross-functional relationships with departmental heads and management across the business spectrum.
- Partners with other operations, clients, L&D and HR function to determine program priorities, roll-out plans, set program deadlines, ROI and analytics.
- Collaborates with departmental heads and managers, to identify areas that require training and to develop program requirements unique to each department. Ability to work closely with key stakeholders in addressing gaps in the overall Solution designs.
(F) Reporting & Analytics:
- Plays an analytical role conducting current and ongoing strategic assessments of business[1]wide training and development programs and initiatives.
- Ensure effective data governance, reporting and measures program delivery quality, which ensures continuous improvement, maintenance, and adjustment in Solutions delivery. (G) Knowledge:
- Guide stakeholders, both internal and external, on the path to the solution while driving executive sign-off.
- Prepare spend estimates, work plans and identify delivery locations while gaining input and buy-in from the legal, finance and delivery teams on approach, solution plan and cost to deliver. Expertise in different pricing models like PMPM, outcome based, transaction and FTE.
(G) Knowledge:
- Guide stakeholders, both internal and external, on the path to the solution while driving executive sign-off.
- Prepare spend estimates, work plans and identify delivery locations while gaining input and buy-in from the legal, finance and delivery teams on approach, solution plan and cost to deliver. Expertise in different pricing models like PMPM, outcome based, transaction and FTE.
Experience & Competencies expected from the Role:
- 18-20+ years of overall experience as a Strong and capable leader that is self-motivated and driven to win the confidence and trust of her/his prospects, clients, global operations, and pursuit teams alike - establishing winning strategies, and exerting influence both internally and externally to win new business.
- Innovative team player with the energy, creativity, and an entrepreneurial spirit to achieve success. A professional who earns respect for his/her leadership, intelligence, and expertise. - Success as a superb relationship builder, negotiator, and communicator.
- 10-12+ years’ experience in U.S healthcare BPO
Payor & Provider Operations
/solutions and preferably from the Payor operations background. - Possess commercial acumen, drive commercial impact (sales, cost reduction projects)
- Acts as a Subject Matter Expert for the sales and client services teams, attends sales calls, demonstrates the products, helps to answer deep questions about the product and works to convince the client we have the best solution.
- Lead and front-end projects (internal – with Ops/IT/BE, external – selling and supporting sales) and lead work through influence to manage stakeholders (internal matrix, client, partner) - Strong communicator who can take complex ideas and communicate them effectively internally, externally and using Project Management tools
- Strong and capable leader that is self-motivated and driven to win the confidence and trust of her/his peers, clients, global operations, and pursuit teams alike establishing winning strategies, and exerting influence both internally and externally to win new business.
- Innovative team player with the energy, creativity, and an entrepreneurial spirit to achieve success. A professional who earns respect for his/her leadership, intelligence, and expertise.
