Healthcare Operations

• Manage day-to-day operations and ensure adherence to SLA, productivity, quality, and compliance targets.
• Coach, mentor, and develop Nurse Associates/CSRs to improve performance and achieve individual and team goals.
• Conduct regular performance reviews, feedback sessions, calibration meetings, and skill-development activities.
• Identify performance and process gaps through root cause analysis and implement corrective and preventive action plans.
• Monitor workload, staffing, productivity, and process volumes in coordination with WFM/MIS and support teams.
• Ensure accurate and timely completion of operational reports, dashboards, trackers, and business reviews.
• Act as a Subject Matter Expert (SME) for healthcare processes, clinical documentation, care management interventions, and problem resolution.
• Ensure team compliance with internal policies, client requirements, HIPAA/confidentiality standards, information security, and applicable healthcare regulations.
• Handle client escalations, member/provider concerns, and complex operational issues, ensuring timely resolution and appropriate communication.
• Support implementation of new processes, policy updates, system changes, training programs, and process improvements.
• Lead calibration sessions and quality initiatives to maintain consistency in clinical decisions, documentation, and customer service.
• Build a positive, collaborative, and high-performance team culture through engagement activities, recognition, coaching, and career development.
• Develop succession plans and career-growth opportunities for team members and prepare high-performing employees for future leadership roles.
• Work closely with Operations Managers, Lead Assistant Managers, Quality, Training, WFM, HR, IT, process owners, Case Managers, providers, and US-based stakeholders.
• Participate in client calls, business reviews, process discussions, and performance meetings as required.
• Promote continuous improvement, innovation, and best practices across the medical management process.

 

Required Skills & Experience:

 

• Strong experience in healthcare/medical management or related healthcare operations.
• Proven experience in team handling, people management, coaching, and performance management.
• Experience managing escalations and complex customer/client issues.
• Good understanding of medical terminology, care management, utilization management, and clinical documentation.
• Knowledge of the US healthcare system is highly desirable.
• Strong analytical, problem-solving, decision-making, and root-cause-analysis skills.
• Ability to interpret operational and performance data and convert insights into actionable improvement plans.
• Excellent communication, presentation, interpersonal, and stakeholder-management skills.
• Strong planning, organization, multitasking, and time-management abilities.
• Ability to work effectively in a fast-paced, target-driven, and multicultural environment.
• Strong customer-service orientation with a focus on quality, compliance, and client satisfaction.
• Ability to manage conflicting priorities and deliver results under pressure.
• Good working knowledge of MS Office and healthcare/business information systems.
• English communication skills equivalent to at least B1 CEF level.