AVP - Claims handling (US Healthcare)

About the Role

AVP – Claims Operations (US Healthcare)

The role oversees multi-location delivery teams, partners with global stakeholders, leads automation and analytics-driven transformation, and manages a portfolio of USD 10–20M. This is a high-impact leadership role reporting into the senior operations leadership team.

Key Responsibilities

Strategic & Operational Leadership

• Lead end-to-end US Healthcare Claims Operations to industry-leading standards.
• Manage large-scale back-office claims functions including PI, SIU, Rework, Enrollment, Coding, Product Build, etc.
• Drive automation, RPA, analytics, and transformation initiatives.
• Manage P&L, budgets, revenue optimization, cost control, and workforce planning.

Client & Stakeholder Management

• Act as the primary operations leader for client engagement, reviews, and performance governance.
• Present insights, solutions, and recommendations for business growth and value creation.

People Leadership

• Lead a span of 800+ FTE across multiple locations.
• Drive performance management, succession planning, training, and employee engagement.

Governance & Compliance

• Ensure adherence to HIPAA, ISO, and internal audit/compliance requirements.
• Own SLA delivery, quality metrics, audits, and performance scorecards.

Ideal Candidate Profile

• 18–20+ years of experience in Healthcare BPM with

  10–12+ years in US Healthcare Claims Operations

  .
• Proven experience managing large delivery teams and multimillion-dollar portfolios.
• Strong domain knowledge of the claims lifecycle and payer operations.
• Demonstrated expertise in transformation, automation, and service delivery excellence.
• Strong communicator, influential leader, and solution-oriented thinker.