About the Role
We are hiring an accomplished AVP Claims Operations (US Healthcare) to lead and transform large-scale claims operations, elevate service delivery, and drive innovation across a major healthcare BPM setup.
The role oversees multi-location delivery teams, partners with global stakeholders, leads automation and analytics-driven transformation, and manages a portfolio of USD 1020M. 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
- 1820+ years of experience in Healthcare BPM with 1012+ 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.
