Healthcare BPO Manager II

Role Summary

The BPO Manager is accountable for end-to-end service delivery, operational excellence, and client satisfaction across healthcare payer BPO workstreams. This role leads multi-functional teams spanning Claims, Enrollment & Billing, Provider Operations, Product Configuration, Contact Center,Clinical management ensuring SLA adherence, quality, productivity, and transformation outcomes.

The ideal candidate brings deep US healthcare domain expertise with hands-on management exposure to payer platform and a proven ability to operate and scale high-performance BPO delivery models.

Key Responsibilities

1. Service Delivery & Operations Ownership

• Own end-to-end delivery across assigned workstreams (Claims, Enrollment and Billing, PDM, Contact Center, etc.) aligned to contractual SLAs
• Drive consistent performance across quality, productivity, TAT, and cost benchmarks
• Ensure adherence to SOPs, compliance frameworks (HIPAA/CMS), and audit readiness
• Lead queue management, workload balancing, and capacity optimization across geographies

2. Client & Stakeholder Management

• Act as the primary operations interface for client counterparts
• Drive governance cadence (weekly/monthly reviews, SLA reporting, RCA discussions)
• Build strong relationships and proactively identify opportunities for value addition and expansion

3. Continuous Improvement & Transformation

• Lead process transformation initiatives using Lean, Six Sigma, and automation levers
• Identify opportunities for AI/automation, workflow optimization, and cost reduction
• Drive RCA-based improvements to enhance quality and prevent defect leakage
• Champion best practices across operations and standardize processes

4. Financial & Commercial Management

• Own unit-level P&L components (cost, productivity, utilization, margins)
• Drive efficiency improvements and cost optimization (onshore/offshore leverage)
• Support business growth via solutioning inputs, RFP responses, and BAFO discussions

5. People Leadership & Talent Development

• Manage large teams across roles (Processors, QA, TLs, SMEs)
• Drive hiring, onboarding, capability building, and succession planning
• Lead performance management, coaching, and retention strategies
• Build domain and platform competency (especially Facets) within teams

6. Risk, Compliance & Governance

• Ensure strict adherence to HIPAA, regulatory, and data security requirements
• Identify and mitigate operational and delivery risks
• Maintain audit readiness and compliance documentation

Experience

• 12+ years of experience in Healthcare BPO / Payer Operations
• Minimum 5+ years in operations leadership / delivery management role
• Proven experience managing multi-workstream, multi-location delivery

Domain Expertise

• Strong understanding of US healthcare payer operations including:
• • Claims (adjudication, adjustments, appeals)
  • Enrollment & Billing
  • Provider Data Management / Credentialing/Contact Center

Facets (Preferred)

• Working knowledge of Facets platform across:
• • Claims processing & adjudication workflows
  • Membership & enrollment modules
  • Billing and accumulators
  • Product configuration / benefits setup
• Exposure to Facets integrations, upgrades, or production support is highly desirable 

Core Skills

• Strong delivery leadership and stakeholder management
• Analytical mindset with data-driven decision-making
• Expertise in SLA/KPI management and reporting
• Process improvement and transformation orientation
• Financial acumen and cost optimization capability
• Excellent communication and executive presence

Key Success Metrics

• SLA adherence (Quality, TAT, Productivity)
• Client satisfaction (CSAT/NPS)
• Cost efficiency and margin improvement
• Attrition and team engagement levels
• Transformation outcomes (automation, productivity gains)