Operation Manager - Medicare Enrollment

Role Overview

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.

Domain Expertise – Medicare & Medicaid

• 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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