Manager I - BPM (US Healthcare and benefit configuration)

Chennai, Tamil Nadu
Permanent
Full-time

2 months ago

Job Description:Role Proficiency:A manager should be able to manage all operations for a process / client depending upon the size of the engagement (typical span: 50-80 associates). meet SLAs while independently drive operational efficiencyOutcomes: * Works closely with the Manager/Group Manager to achieve quantitative and qualitative SLAs and KPIs for the team.

Focuses on planning and execution to ensure quality improvement turnaround time and overall process efficiency.
Identifies process gaps and collaborates with the client to formulate solutions for the same.
Regularly interacts with the Quality team to ensure real time action in cases of quality defects.
Leads corrective and preventive action plans for various transactions and owns them.
Ensures that leads are informed on all process and business updates; and the relevant information is cascaded to associates in every team to ensure transparent communication.
Set clear team goals and transparent objectives on what the team is working towards to ensure clarity.

Measures of Outcomes: * 100% Adherence to quality standards process and SLA’s

Number of issues resolved and tasks completed
Number of non-compliance issues with respect to SOP
Zero/No Client Escalations
Percent of completion of all mandatory training requirements
Percent of QC and QA scores
RCA and Corrective Action Plans
Daily/weekly performance reporting
Number of high-quality RCA and QA output
Guides and mentors the junior associates.
Swift turnaround time for response and resolution
Update SOPs and job aids on a weekly basis
Delegate tasks and set deadlines for the team

Outputs Expected:Operations: * Ensure team handles the work received and adheres to SLAsQuality: * Responsible for creating quality plans and implementing quality management functionCommunication: * Responsible for reporting and communicating with client and internal team members.

Communicates with clients daily and provides status update

obtains feedback and acts immediately on any issues highlighted. * Provides status update to the respective stakeholders and within the team

Shares performance reports to the client at the end of every month on team output and productivity.

Process/efficiency Improvement: * Proactively identify opportunities to increase service levels and mitigate any issues in delivery within the function or across functions. Take accountability for overall productivity efforts within the functionincluding coordination of function specific tasks.Training: * On time completion of all mandatory training requirements of organization and customer. Provide on floor training and one on one mentorship for new joiners. Complete certification of respective career paths.Performance Management: * Update FAST Goals in NorthStartrack
report and seek continuous feedback from peers and manager. Set goals for team members and mentees and provide feedback.Escalation: * Escalate problems to appropriate individuals/support team based on established guidelines and procedures.Monitoring: * Monitors progress of requests for support and ensures users and other interested parties are kept informed.Process Adherence: * Thorough understanding of organization and customer defined process. Consult with mentor when in doubt. Adherence to defined processes. Adhere to organization’ s policies and business conduct.Manage knowledge: * Consume project related documentsshare point
libraries and client universitiesIssue Resolution: * Identifiesanalyses and solves the incidents/transactions. * Perform root cause analysis to find corrective and preventive actions after every major incident and escalations. Work closely with team members to solve customer problems.

Understand agent's problems and weaknesses and address

Release: * Adhere to release management processTeam management: * Set expectations; manage performance of team and individuals.

Provide regular feedback.
Coach team towards operational excellence.
Recognize high performing talents in the team and reward them.

Mentoring: * Guide new team members in understanding customer infrastructure and processes.

Mentoring and providing guidance to the peers and junior associates.
Assist new team members to understand the customer environment.

Management: * Able to make decisions on any matters relating to improving revenue generation and customer satisfaction with regards to call handling and call center processes.Skill Examples: * Customer Focus: Focus on providing a prompt and efficient service to customers; goes out of the way to ensure that individual customer needs are met.

Attention to detail to ensure metrics quality and production output and reporting is accurate
Team Work: Respect others and work well within the team.
Communication: Speak clearly and write in a clear and concise manner. Uses appropriate style and language for communication (Data)
Communication: Speaks in an accent neutral manner or with the accent required for the process with good vocabulary and grammar skills. Writes clearly (Voice)
Analysis and Decision Making: Makes judicious and fair decisions after examining all relevant information and making clear assumptions
Team Coaching and Leadership: Lead the team by example. Guide and support the team towards the achievement of goals.
Coaches and guides lead’s in managing outcomes and expectations well.
Manage and facilitate aspirations and skill development for team.
Proactive in avoiding or resolving conflicts.
Planning skills: Translate business objectives into functional activities. Set goals and processes and organize resources to ensure that the desired results are met.
Excellent communication and leadership skills.
Organizational and time management skills.
Assistant Manager - Operations Training Quality MIS Process Excellence
Leadership role with span of up to 60 FTE

Knowledge Examples:

Familiar with Windows Operating Systems MS Office
Excellent English comprehension – reading writing and speaking
Domain knowledge based on process (healthcare banking investment F&A retail customer support etc)
Expertise with process knowledge and guidelines
Expertise in work allocation and intake functions
Expertise in MS Excel
Expertise with quality control processes including pare to analysis and root cause analysis
Typing speed with 15WPM and 80% accuracy Voice
Typing speed with 30WPM and 95% accuracy Data
Experience level – 9 to 12 years

Additional Comments:Job Summary: We are seeking an experienced BPO Manager to lead and manage our offshore BPO operations for a US Healthcare Payer. The ideal candidate will be responsible for overseeing benefit configuration, claims processing, provider data management, and other payer-related functions. This role requires a deep understanding of US healthcare regulations, payer systems, industry best practices, and SLA-driven service delivery to ensure operational excellence, compliance, and client satisfaction. Key Responsibilities: Operations Management: • Oversee and manage end-to-end operations for different workstreams / US healthcare payer functions, including benefit configuration, claims adjudication, provider data management, enrollment, and member services. • Establish and Ensure operational KPIs, SLAs, and quality metrics are met or exceeded, with a strong focus on TAT (Turnaround Time), Accuracy, Productivity, and First Pass Yield. • Develop and maintain scorecards and performance dashboards to track key operational metrics. • Drive operational efficiencies by implementing process optimization, automation, and continuous improvement initiatives. • Work closely with onshore stakeholders and clients to align offshore operations with business objectives and service expectations. • Oversee benefit setup, configuration, validation, and testing in payer platforms (HealthEdge, or similar systems). • Exposure to managing complex claim scenarios, including coordination of benefits (COB), prior authorizations, adjustments, and appeals processing. • Develop and implement strategies to minimize rework, leveraging root cause analysis and predictive analytics. Compliance & Quality Assurance: • Ensure strict adherence to US healthcare regulations (HIPAA, CMS, ACA, etc.) and payer compliance standards. • Implement quality control frameworks to minimize errors and improve First Pass Adjudication Rate (FPAR). • Conduct regular audits, RCA (Root Cause Analysis), CAPA (Corrective and Preventive Actions), and process improvements. • Develop and enforce SOPs (Standard Operating Procedures) and compliance policies aligned with industry standards. Performance & SLA Management: • Define and manage Service Level Agreements (SLAs) and Key Performance Indicators (KPIs) to ensure operational excellence. • Develop and maintain scorecards, dashboards, and governance reports to track performance against contractual commitments. • Drive initiatives to improve accuracy, efficiency, and cost-effectiveness, ensuring optimal resource utilization and workload balancing. • Lead monthly and quarterly business reviews (MBRs & QBRs) with clients and internal stakeholders to assess performance and drive improvements. People & Stakeholder Management: • Lead and mentor a team of healthcare BPO professionals, including team leads, analysts, and quality specialists. • Drive employee engagement, training, and performance management initiatives to enhance skill development and retention. • Act as a point of escalation for process-related and client concerns, ensuring timely resolution and customer satisfaction. • Foster strong relationships with clients, onshore teams, and internal stakeholders to ensure seamless service delivery and alignment with business goals. Technology & Process Improvement: • Leverage automation, AI/ML, and analytics to optimize operational workflows and improve decision-making. • Collaborate with IT and process teams to implement RPA (Robotic Process Automation) and AI-driven solutions to enhance process efficiencies. • Stay updated on emerging payer technologies and industry trends to drive innovation and digital transformation. Key Skills & Qualifications: • 8+ years of experience in US healthcare payer operations within a BPO environment, preferably in an Indian IT/BPO services company. • Strong expertise in benefit configuration, claims processing, adjudication, and compliance. • Hands-on experience with healthcare payer platforms (HealthEdge, or similar). • In-depth knowledge of US healthcare regulations (HIPAA, CMS guidelines, Medicare, Medicaid, ACA, etc.). • Proven ability to manage large teams and drive performance improvements through SLA/KPI management and scorecards. • Experience with process automation (RPA, AI, analytics) and workflow optimization preferred • Strong analytical, problem-solving, and leadership skills. • Lean/Six Sigma certification (preferred but not mandatory). • Should be flexible to work in shifts. If general shift, should require overlap of minimum 3 hours (until 9PM IST) • Should be willing to work from office (5 days) covering required 8 hours per day.Skills:Us Healthcare,Claims Processing,Compliance,Claims AdjudicationAbout Company:UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.

UST

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