Job Description

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Job Summary \xe2\x80\x93

Senior Manager of Healthcare Payer Operations is responsible for overseeing and optimizing the operational processes within the backoffice functions including managing voice-based backoffice processes. With a minimum of 15 years of experience in healthcare operations, the Senior Manager will lead a team and collaborate with cross-functional departments to ensure efficient, compliant, and customer-centric operations.k

Responsibilities:

Lead a team of managers, supervisors, and operational staff, fostering a culture of collaboration, continuous improvement, and operational excellence.

Develop and implement strategic plans for backoffice operations, incorporating voice-based processes in member or provider call centers, aligned with organizational goals, regulatory requirements, and industry best practices.

Monitor and improve operational processes, workflows, and systems to enhance efficiency, accuracy, and member/provider satisfaction in call center interactions.

Collaborate closely with claims processing, enrollment, customer service, and finance departments to ensure seamless integration of voice-based processes with other operational areas.

Analyze operational metrics and data from call center interactions to identify trends, challenges, and opportunities for enhancement, presenting findings to senior leadership.

Ensure compliance with healthcare industry regulations, including HIPAA, and champion data security and privacy initiatives.

Establish and nurture relationships with external vendors and partners related to call center technology and services.

Contribute to change management efforts, supporting the adoption of new technologies, process improvements, and organizational changes.

Prepare and present regular reports on operational performance in call center activities, highlighting achievements, challenges, and strategic recommendations.

Knowledge Requirements:

Bachelor\xe2\x80\x99s degree in healthcare administration, Business Management, or a related field. Master\'s degree preferred.

Minimum of 15 years of progressive experience in healthcare payer operations management, with emphasis on managing voice-based processes in member or provider call centers.

Comprehensive understanding of healthcare payer industry trends, regulations, and operational best practices, especially.

Profound knowledge of claims processing, enrollment, premium billing, and related operational areas, with expertise in integrating voice processes.

Proven leadership experience in managing and developing high-performing teams, specifically within call center environments.

Expertise in process optimization, workflow design, and operational efficiency methodologies (e.g., Lean, Six Sigma).

Familiarity with healthcare information systems, data analytics, and technology solutions relevant to backoffice operations and call centers.

Strong communication skills, both written and verbal, with the ability to collaborate and influence across organizational levels.

Strategic mindset to translate organizational objectives into actionable operational plans.

Exceptional problem-solving abilities and adept at making informed decisions in complex, fast-paced call center environments.

Experience in managing vendor relationships and driving vendor performance and services.

Proficient in project management and change management methodologies.

Strong presence as a leader, fostering a culture of accountability, innovation, and continuous improvement.

Years of experience needed \xe2\x80\x93

15+ years

Technical Skills:

Working knowledge of Healthcare Information Systems, Data Analytics and Reporting, Process Automation and Workflow, Regulatory and Compliance, EHR, EDI, Project Management, P&L

Certifications Needed:

Relevant Healthcare industry specific certifications preferred.

About Mphasis

Mphasis applies next-generation technology to help enterprises transform businesses globally. Customer centricity is foundational to Mphasis and is reflected in the Mphasis\xe2\x80\x99 Front2Back\xe2\x84\xa2 Transformation approach. Front2Back\xe2\x84\xa2 uses the exponential power of cloud and cognitive to provide hyper-personalized (C=X2C2TM=1) digital experience to clients and their end customers. Mphasis\xe2\x80\x99 Service Transformation approach helps \xe2\x80\x98shrink the core\xe2\x80\x99 through the application of digital technologies across legacy environments within an enterprise, enabling businesses to stay ahead in a changing world. Mphasis\xe2\x80\x99 core reference architectures and tools, speed and innovation with domain expertise and specialization are key to building strong relationships with marquee clients.

Skills:

PRIMARY COMPETENCY : Healthcare PRIMARY SKILL : Non-Voice PRIMARY SKILL PERCENTAGE : 100

About Company:

Mphasis is a leading IT solutions provider, offering Applications, Business Process Outsourcing (BPO) and Infrastructure services globally through a combination of technology knowhow, domain and process expertise. The accolades we have been garnering can be attributed to our undeterred focus in delivering quality solutions across verticals that meet the challenging requirements of our esteemed customers. We have been recently felicitated by the economic times as the most distinguished digital company 2015. We have also been ranked 29 of 100 largest financial technology vendors by American Banker and BAI in the FinTech Forward Top 100 rankings.

Mphasis