Manager I BPM - Claims Operations Lead

Key Responsibilities

• Lead the end-to-end transition and operational delivery of FACETS Claims Operations, ensuring successful knowledge acquisition, operational readiness, stabilization, and seamless transition to steady-state support.
• Act as the primary client-facing lead and trusted advisor for Claims Operations, managing executive stakeholder relationships, governance forums, risk reviews, and operational decision-making.
• Partner with client SMEs and business leaders to assess current-state operations, define future-state operating models, and establish service delivery frameworks.
• Drive transition planning, knowledge transfer execution, readiness assessments, and operational acceptance activities to ensure a successful handoff to delivery teams.
• Oversee FACETS claims adjudication operations, ensuring adherence to productivity, quality, accuracy, turnaround time, and SLA commitments.
• Establish governance processes, performance metrics, reporting dashboards, and controls to monitor operational performance and deliver continuous visibility to stakeholders.
• Identify operational risks, process gaps, dependencies, and improvement opportunities, implementing mitigation plans and corrective actions to ensure delivery stability.
• Collaborate with cross-functional teams including Enrollment, Provider Operations, Configuration, Application Support, and Technology teams to drive end-to-end process effectiveness.
• Lead continuous improvement, automation, and transformation initiatives to enhance operational efficiency, quality, customer experience, and business outcomes.
• Provide leadership, coaching, and direction to onshore and offshore operations teams, fostering a culture of accountability, collaboration, and operational excellence.
• Support workforce planning, capacity management, forecasting, and resource optimization to align with client demand and business objectives.
• Ensure compliance with healthcare payer regulations, client policies, audit requirements, and operational governance standards.
• Lead Healthcare BPM delivery and operations management, ensuring SLA adherence, productivity targets, quality performance, operational governance, and continuous process improvement.
• Drive BPM transformation initiatives, process standardization, automation opportunities, operational excellence programs, and service delivery optimization across healthcare payer operations.
• Manage Healthcare BPM/BPO delivery teams, stakeholder governance, performance management, and operational reviews to achieve business outcomes and customer satisfaction goals.

Required Qualifications

• 10+ years of Healthcare Payer Operations and BPM/BPO Operations experience with deep expertise in FACETS Claims Processing and Adjudication.
• Proven experience leading large-scale transition, transformation, and managed services engagements.
• Strong understanding of Commercial, Medicare, Medicaid, and Government Programs claims operations.
• Demonstrated success managing client relationships, operational governance, service delivery, and cross-functional teams.
• Experience managing large-scale onsite/offshore BPM delivery teams.
• Strong knowledge of SLA management, productivity management, operational governance, workforce management, and continuous improvement methodologies.
• Excellent communication, stakeholder management, and leadership skills.

Preferred Qualifications

• Experience leading Healthcare BPM transformation programs.
• Exposure to Lean Six Sigma, Process Excellence, Automation, and AI-enabled operational transformation initiatives.
• Knowledge of FACETS and Healthcare Payer operational workflows across Claims, Enrollment, Provider, Billing, and Configuration functions.

Success Measures

• SLA/KPI Compliance.

• 10+ Years in Healthcare Payer Operations, BPM Operations, and FACETS Claims Processing.

TekWissen Group is an equal opportunity employer supporting workforce diversity.