Operation Manager - Medicare Enrollment

Firstsource; Bengaluru; On-site; INR 1,500,000 - 2,500,000; Full time

Job summary

A leading BPO provider in Bengaluru is seeking an Operations Manager to oversee Medicare enrollment and claims operations for U.S. clients. The ideal candidate will have 8-12 years of experience in U.S. healthcare operations and at least 3 years in management positions. Responsibilities include leading large teams, ensuring service quality, and managing client relations. Strong knowledge of Medicare processes and leadership skills are required. The role offers the opportunity to influence operational workflows in a fast-paced environment.

Qualifications

• 8-12 years of experience in U.S. healthcare operations, with at least 3+ years in managerial roles.
• Strong knowledge of Medicare enrollment and claims processes.
• Experience managing mid to large teams in a BPO/TPA/payor setup supporting U.S. clients.

Responsibilities

• Lead and manage teams handling Medicare/Medicaid enrollment and claims processing.
• Ensure operational targets for productivity and quality are consistently met.
• Serve as primary operational point of contact for U.S. clients and business partners.

Skills

Leadership

Communication

Client Management

Healthcare Domain Knowledge

Process Improvement

Job description

The Operations Manager will lead and oversee teams managing Medicare enrollment, eligibility, and claims operations for U.S. healthcare clients. This role ensures high-quality delivery, process compliance, productivity optimization, and effective stakeholder communication. The ideal candidate has strong U.S. healthcare domain expertise, hands-on leadership experience, and the ability to manage large teams in fast-paced environments.

Key Responsibilities

Operations Leadership

• Lead and manage teams handling Medicare/Medicaid enrollment, eligibility verification, and claims processing.
• Ensure daily operational targets for productivity, quality, SLAs, and turnaround times are consistently met.
• Oversee end-to-end workflow management including work allocation, monitoring, and performance tracking.
• Implement best practices to improve accuracy and reduce operational defects.
• Deep understanding of CMS guidelines, enrollment processes, and claims lifecycle.
• Provide subject‑matter guidance on Part A/B/D, Advantage plans, Medicaid eligibility rules, and state-specific policies.
• Monitor CMS updates and ensure compliance across the team.

People & Performance Management

• Lead a team of 20–60+ associates/analysts (depending on volume).
• Conduct performance reviews, coaching, and skill‑building sessions.
• Manage team hiring, onboarding, training, and succession planning.
• Drive a culture of accountability, continuous improvement, and employee engagement.

Client Interaction & Stakeholder Management

• Serve as primary operational point of contact for U.S. clients and business partners.
• Participate in governance calls, present performance dashboards, and manage escalations effectively.
• Translate client expectations into operational workflows and deliverables.

Process Improvement & Compliance

• Ensure adherence to CMS, HIPAA, and organization compliance standards.
• Identify automation/optimization opportunities and lead improvement initiatives (Lean/Six Sigma preferred).
• Conduct root-cause analysis for defects, escalations, and audit findings.

Reporting & Analytics

• Prepare daily/weekly/monthly dashboards on productivity, quality, SLA adherence, and workforce planning.
• Analyze operational trends to make data-driven recommendations.

Required Skills & Qualifications

• 8–12 years of experience in U.S. healthcare operations with at least 3+ years in managerial roles.
• Strong knowledge of Medicare enrollment and claims processes.
• Experience managing mid to large teams in a BPO/TPA/payor setup supporting U.S. clients.
• Familiarity with CMS regulations, eligibility guidelines, and claims adjudication workflows.
• Excellent leadership, communication, and client management skills.
• Ability to work in US shifts and manage cross‑functional stakeholders.

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