Delivery Head - Healthcare - Insurance process

Job Description: Delivery Head Healthcare BPO / RCM

Location:

Key Roles & Responsibilities

1. Delivery Operations:

   Lead end-to-end healthcare BPO delivery operations, ensuring operational excellence, productivity, accuracy, and consistent service delivery.

2. Healthcare RCM Expertise:

   Manage transactional Revenue Cycle Management (RCM) processes, including medical billing, claims processing, claims adjudication, and document indexing.

3. Claims Processing:

   Oversee professional claims using HCFA-1500 and institutional claims using UB-04 forms, ensuring data accuracy and adherence to payer requirements.

4. SLA & KPI Management:

   Drive key performance indicators, including turnaround time (TAT), First Pass Clean Claim Rate, charge capture accuracy, quality, and productivity.

5. 24x6 Operations Management:

   Manage round-the-clock delivery operations, shift planning, workforce deployment, and resource utilization to ensure uninterrupted service delivery.

6. Compliance & Data Security:

   Ensure adherence to HIPAA, HITECH, patient data confidentiality, information security policies, and clean-desk standards.

7. Client & Stakeholder Management:

   Act as the primary point of contact for international clients, managing escalations, performance reviews, and strategic operational discussions.

8. Performance Improvement:

   Conduct root cause analysis (RCA), implement corrective and preventive actions, and drive continuous improvement initiatives to reduce errors and improve efficiency.

9. Team Leadership:

   Lead and develop large delivery teams of 150+ FTEs through performance management, coaching, succession planning, and leadership development.

10. Capacity & Workforce Planning:

    Partner with Workforce Management (WFM) to optimize staffing, multi-skilling, capacity planning, and resource allocation in line with business volumes.

11. Financial & P&L Management:

    Manage account financial performance, operating costs, revenue per seat, billing utilization, productivity, and operational margins.

12. Business Reviews & Reporting:

    Lead weekly performance reviews, Monthly Business Reviews (MBRs), and Quarterly Business Reviews (QBRs), presenting operational insights and action plans.

13. Talent Retention & Engagement:

    Drive employee engagement, retention, and career development initiatives while managing attrition and maintaining a strong leadership pipeline.

14. Process Governance & Risk Management:

    Establish robust process controls, audit readiness, documentation standards, and risk mitigation measures to maintain operational stability.

15. Business Growth & Transformation:

    Identify opportunities for process optimization, automation, scalability, and service delivery enhancement to support account growth and client satisfaction.

Candidate Profile :-

• 12 to 16 years of experience in BPO/ITES, including at least 3 years in a Delivery Head or Senior Operations leadership role.
• Strong hands-on experience in US Healthcare RCM, medical billing, claims processing, and payer operations.
• Proven experience managing large teams of 150+ FTEs in 24x6 or 24x7 operations.
• Strong knowledge of HIPAA, HITECH, SLA management, operational metrics, and client relationship management.
• Bachelor's or Master's degree in Business, Commerce, Information Systems, or a related discipline.
• Six Sigma Green Belt or Black Belt certification will be an added advantage.
• Excellent leadership, analytical, communication, stakeholder management, and problem-solving skills.