Senior Operations Manager (Medical Claim Digitization)

Connectandheal; Mumbai; On-site; INR 3,500,000 - 5,500,000; Full time

Job summary

Connectandheal in Mumbai seeks a Senior Operations Manager (Medical Claim Digitization) with 8-10 years of experience to lead end-to-end digitization operations across multiple accounts, ensuring SLAs, TAT, quality, and profitability.

The role focuses on governance, workforce planning, and capability building, with adherence to IRDAI guidelines and data security standards, including travel for governance meetings.

Qualifications

• 8–10 years of overall operations experience.
• Minimum 5+ years in Healthcare Claims/Medical Claims digitization.
• Experience leading large teams and multiple client accounts.

Responsibilities

• Lead end-to-end medical claim digitization operations across multiple clients.
• Drive strategy to improve TAT, quality, productivity, and profitability.
• Establish scalable operating models and governance frameworks.
• Oversee client governance, performance reviews, and stakeholder management.
• Plan workforce and succession, shift planning, and capacity utilization.
• Ensure compliance with IRDAI and information security standards.
• Monitor risks, drive RCA/CAPA, and report to leadership.
• Track SLA, TAT, accuracy, productivity, attrition, and customer satisfaction.

Skills

Team Management

Operations Leadership

Healthcare Claims

Digitization

Education

Graduate / Postgraduate

MBA

Job description

Senior Operations Manager (Medical Claim Digitization)

8 - 10 years

Full-Time

Role Purpose:

The Senior Operations Manager will be responsible for leading end-to-end medical claim digitization operations across multiple accounts/projects, ensuring achievement of business objectives, client SLAs, TAT, quality, productivity, profitability, and operational excellence.

The role requires ownership of large-scale operations, client governance, workforce strategy, process transformation, technology adoption, and capability building to support business growth.

Key Responsibilities:

1. Strategic Operations Leadership

• Lead and manage end-to-end medical claim digitization operations across multiple clients and processes.
• Drive operational strategy to deliver sustainable improvements in TAT, quality, productivity, and profitability.
• Establish scalable operating models to support business growth and changing client requirements.
• Own operational governance and business continuity planning.

2. Client & Business Management

• Serve as the senior operational interface for client leadership teams.
• Lead governance forums, business reviews, and operational discussions.
• Drive client satisfaction through delivery excellence and proactive stakeholder management.
• Support commercial discussions including pricing, SOW reviews, penalties, change requests, and operational feasibility.
• Partner with business teams for account growth, renewals, and expansion opportunities.

3. Service Delivery Excellence

• Ensure achievement of committed SLAs including:
  • Turnaround Time (TAT)
  • Quality and Accuracy
  • Productivity
  • Capacity Utilization
  • Cost Efficiency
• Monitor daily operations and proactively manage risks impacting delivery.
• Drive RCA and CAPA for operational deviations.

4. Workforce Planning & Resource Management

• Own manpower planning based on forecasted and actual business volumes.
• Build hiring plans and succession pipelines.
• Drive shift planning, roster management, leave governance, and utilization optimization.
• Ensure operational readiness for seasonal spikes and new implementations.

5. Quality, Audit & Compliance

• Build quality frameworks to ensure high accuracy in medical claim digitization.
• Ensure adherence to client guidelines, contractual obligations, IRDAI requirements, and information security standards.
• Lead internal and external audits.
• Drive continuous improvement programs to enhance quality outcomes.
• Lead Operations Managers, Team Leaders, Quality teams, Trainers, and support functions.
• Drive leadership capability and succession planning.
• Build a performance-oriented and accountable culture.
• Coach teams on operational excellence and client management.

9. Governance & Reporting

• Present performance reviews to senior leadership and clients.
• Track:
  • TAT Compliance
  • Accuracy %
  • Productivity
  • Forecast vs Actual Volumes
  • Attrition
  • SLA Achievement
  • Customer Satisfaction
  • Financial Performance

Key Performance Indicators (KPIs):

• SLA & TAT Achievement
• Quality / Audit Scores
• Productivity per FTE
• Forecast Accuracy
• Attrition & Engagement
• Automation Adoption

Required Qualifications:

• Graduate / Postgraduate (Healthcare Management / Operations / Business preferred)
• MBA preferred

Experience:

• 8 - 10 years of overall operations experience
• Minimum 5+ years in Healthcare Claims / Medical Claims - Digitization Operations
• Experience managing large teams and multiple client accounts
• Strong exposure to transition, transformation, and client governance

Working Conditions:

• Flexibility to support business and client requirements
• Readiness to manage peak operational periods
• Ability to travel for client and governance meetings as required

Required Skills

Team Handling Digitization Operations Medical Claims Healthcare Claims