Manager Claims Audit

Key Responsibilities:

1. Strategic Coordination and Alignment
   1. Serve as the key liaison between POD Leader and Operations/Program Leaders to ensure alignment on client engagement, requirements, and escalation management.
   2. Align POD-level goals with program objectives and the broader business strategy.
   3. Partner with Program and POD Leaders for strategic planning, including forecasting performance, capacity planning, and staffing to meet revenue goals.
2. Audit Life Cycle Management:
   1. Collaborate across functions to ensure effective service delivery throughout the audit lifecycle—from data management and selections to recovery.
   2. Review exceptions, analyze anomalies, and provide insights with appropriate narrative and resolution actions.
   3. Monitor audit KPIs, SLAs including volume, capacity, forecasting, audit completion, TATs, priority completions, and recovery & collection
3. Client Engagement:
   1. Maintain dual accountability with Program Leaders for client-facing communications and engagement.
   2. Respond to adhoc client needs, compliance, and administrative requirements promptly.
   3. Ensure timely and appropriate client communication alongside Program Leaders.
4. Analytics and Technology:
   1. Lead analytics initiatives in collaboration with Program Leaders for business intelligence and advanced reporting solutions.
   2. Drive technology initiatives to enhance operational efficiencies and work closely with Program Leaders on solutioning.
5. Service Delivery Excellence & Operational Efficiency
   1. Conduct continuous 360-degree reviews of service delivery and identify improvement areas.
   2. Work with Program Leaders to uphold high standards and timely delivery of all reports to senior leadership.
   3. Identify revenue leakage and bottlenecks; collaborate cross-functionally to implement scalable solutions.
   4. Facilitate regular review meetings with Program and POD Leaders to discuss progress and insights.
   5. Present performance metrics, revenue trends, and risk assessments to senior management.
6. Digital Transformation
   1. Collaborate with Digital Engineering and Tech teams to evaluate and implement automation and analytics tools aligned with business objectives.

1. Bachelor’s degree in any or related field; MBA or relevant advanced degree preferred.
2. Experience: Minimum of 10 years’ experience in US Healthcare and Payment Services LOB preferred.
3. 5+ years of experience in operations management, preferably in audit lifecycle or service delivery domains.
4. Proven experience in strategic planning, client engagement, and cross-functional team leadership.
5. Strong analytical skills with proficiency in metrics tracking, reporting, and business intelligence tools.
6. Excellent communication skills with client-facing experience.
7. Ability to manage multiple stakeholders and complex escalations effectively.
8. Experience with compliance standards (HIPAA, CMS) and quality assurance.
9. Familiarity with digital transformation initiatives and technology-driven process improvements.

Manager - POD Operations: Key Responsibilities

Working Hours: 40 HOURS PER WEEK, FULL TIME EMPLOYEE.

Key Competencies:

1. Strategic Thinking & Alignment
2. Analytical & Data-Driven Decision Making
3. Client Relationship Management
4. Cross-Functional Collaboration
5. Problem Solving & Escalation Management
6. Process Improvement & Operational Excellence
7. Leadership & Team Management

Strategic Coordination: Facilitate seamless alignment and collaboration between POD and Program operations to support overall business goals.

Audit Lifecycle Oversight: Manage the end-to-end audit process, ensuring timely, accurate, and compliant execution of audits.

Service Delivery Excellence: Drive continuous improvements in service quality to enhance client satisfaction and operational performance.

Client Relationship Management: Build and maintain strong client relationships, addressing their needs and resolving issues promptly.

Support Growth Initiatives: Partner with business development teams to identify and enable growth opportunities within POD operations.

Analytics and Technology Enablement: Lead adoption of data analytics and technology tools to improve decision-making and operational efficiency.

Compliance Management: Ensure all processes comply with regulatory requirements and internal policies, addressing any gaps proactively.

Stakeholder Engagement: Act as a bridge between key stakeholders, facilitating clear communication and collaboration.

Revenue Optimization: Identify and implement strategies to maximize revenue and profitability within POD operations.

Operational Efficiency: Continuously optimize workflows and processes to reduce costs, increase productivity, and meet performance targets.