Role Overview
The Operations Manager will lead and oversee teams managing Medicare enrollment, eligibility, and claims operations for U.S. healthcare clients. This role ensures high-quality delivery, process compliance, productivity optimization, and effective stakeholder communication. The ideal candidate has strong U.S. healthcare domain expertise, hands-on leadership experience, and the ability to manage large teams in fast-paced environments.
Key Responsibilities
Operations Leadership
- Lead and manage teams handling Medicare/Medicaid enrollment, eligibility verification, and claims processing.
- Ensure daily operational targets for productivity, quality, SLAs, and turnaround times are consistently met.
- Oversee end-to-end workflow management including work allocation, monitoring, and performance tracking.
- Implement best practices to improve accuracy and reduce operational defects.
Domain Expertise – Medicare & Medicaid
- Deep understanding of CMS guidelines, enrollment processes, and claims lifecycle.
- Provide subject‑matter guidance on Part A/B/D, Advantage plans, Medicaid eligibility rules, and state-specific policies.
- Monitor CMS updates and ensure compliance across the team.
People & Performance Management
- Lead a team of 20–60+ associates/analysts (depending on volume).
- Conduct performance reviews, coaching, and skill‑building sessions.
- Manage team hiring, onboarding, training, and succession planning.
- Drive a culture of accountability, continuous improvement, and employee engagement.
Client Interaction & Stakeholder Management
- Serve as primary operational point of contact for U.S. clients and business partners.
- Participate in governance calls, present performance dashboards, and manage escalations effectively.
- Translate client expectations into operational workflows and deliverables.
Process Improvement & Compliance
- Ensure adherence to CMS, HIPAA, and organization compliance standards.
- Identify automation/optimization opportunities and lead improvement initiatives (Lean/Six Sigma preferred).
- Conduct root-cause analysis for defects, escalations, and audit findings.
Reporting & Analytics
- Prepare daily/weekly/monthly dashboards on productivity, quality, SLA adherence, and workforce planning.
- Analyze operational trends to make data-driven recommendations.
Required Skills & Qualifications
- 8–12 years of experience in U.S. healthcare operations with at least 3+ years in managerial roles.
- Strong knowledge of Medicare enrollment and claims processes.
- Experience managing mid to large teams in a BPO/TPA/payor setup supporting U.S. clients.
- Familiarity with CMS regulations, eligibility guidelines, and claims adjudication workflows.
- Excellent leadership, communication, and client management skills.
- Ability to work in US shifts and manage cross‑functional stakeholders.
⚠️ Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels.
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