Claims Operations - Senior Manager Solutions - GR - 31089 - 50358 - JR135529

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Job Description:

Job Title

Senior Manager - Solution

Requirement Type

Full-Time Employee

Job Location

Bangalore/Hyderabad/Gurugram

Requirement Level

Senior Manager

Hiring Manager

Director Commercialization

Primary Skill

Claims Operations

Business

Commercialization

Skill Category

Generic

ABOUT ELEVANCE HEALTH

Elevance Health is a leading health company in America dedicated to improving lives and communities and making healthcare simpler.  It is the largest managed health care company in the Blue Cross Blue Shield (BCBS) Association serving more than 45 million lives across 14 states.

A regular in Fortune 500 list, Elevance Health ranked 20 in 2022. Gail Boudreaux, President and CEO of Elevance Health has been a consistent name in the Fortune list of most powerful women and currently holds 4th rank on this list.

ABOUT CARELON

Carelon Global Solutions (CGS) is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

Previously known as Legato Health Technologies, Carelon Global Solutions (hereinafter, CGS) underwent a name change and joined the Carelon family of brands in January 2023, as a fully owned subsidiary of Elevance Health (Previously Anthem Inc.). CGS brings together a global team of like-minded innovators who manage and optimize operational processes for health plans as well as providers.

Our brightest minds housed across our global headquarters in Indianapolis as well as Bengaluru, Hyderabad and Gurugram in India, Manila in the Philippines, Limerick in Ireland and San Juan in Puerto Rico bring with them innovative capabilities and an unmatched depth of experience. This global team uniquely positions CGS to enable scalable, next-generation platforms and specialized digital tools that make healthcare operations more practical, effective and efficient.

OUR MISSION & VALUES

Our Mission: Improving Lives and Communities. Simplifying Healthcare. Expecting More.
Our Values: Leadership | Community | Integrity | Agility | Diversity

JOB POSITION

The Senior Manager- Solution position is responsible to drive Quality engineering process standardization and adherence across organization. The role has to enable the delivery team for quality rigor, predictability, analysis of leading/lagging metric insights and bring down cost of quality. Role also act as reviewer for all the process standardization and adherence across organization and certify that project are executed as per standards.

JOB RESPONSIBILITY

• Build Best-in class Quality Management System (QMS) from the internal and Industry best practices (Process, Template, Checklist, SOP, guidelines across BO, Tech, Agile, Waterfall).
• Responsible to manage Quality Management System (QMS) and its currency to industry trends and
  Carelon Requirements.
• Coach the delivery team in first time right quality culture, adoption of QMS practices and champion trainings.
• Ensure code quality, coding standards and peer reviews are followed in all the projects.
• Ensure Delivery tools are adopted across all the projects.
• Provide SME expertise in metrics definition, tracking and insights at tower and India level.
• Develop best-in class trends and analytics and help define organizational quality goals for future.
• Ensure Risk Management across all projects and highlight tower/organization level Risks and mitigations.
• Ensure Root Cause analysis (RCA) are completed, and corrective action are implemented in both Tech/BO Tower.
• Drive Knowledge management process (lesson learnt, best practices, any best-in class process/templates) across organization.
• Enforce knowledge codification, sharing and refresh across organization.
• Lead organization level Continuous Improvement (CI) initiatives.
• Report and governance on risks, project need attention, metrics deviations and potential escalations.
• Conduct quarterly quality Spot-check to verify QMS adoption, best practices and recognize for best projects.
• Experience in tools like Minitab and Confluence.
• Experience in independently driving QMS development and roll-out.
• Experience in running large Delivery Governance forums.

QUALIFICATION

• BE/B.Tech/MCA

EXPERIENCE

• Preferred Minimum experience: 20 years
• Proficiency in the full spectrum of claims domain is necessary.
• A deep understanding of the entire claims lifecycle, from origination to processing and payment, is crucial.
• A solid understanding of both the IT and Operations aspects is essential.

SKILLS AND COMPETENCIES

• Ability to communicate at all levels with clarity and precision both written and verbally, good listener
• Ability to multi-task and switch context to changing priorities in a highly dynamic environment
• Excellent presentation and reporting skills to executive level audiences
• Good Strategic thinking and problem-solving skills
• Multi-project management/portfolio management experience
• Business acumen

THE CARELON PROMISE

Aligning with our brand belief of ‘limitless minds are our biggest asset’, we offer a world of limitless opportunities to our associates.

It is our strong belief that one is committed to a role when it is not just what the role entails, but also what lies in its periphery that completes the value circle for an associate.

This world of limitless opportunities thrives in an environment that fosters growth and well-being, and gives you purpose and the feeling of belonging.

LIFE @ CARELON

• Extensive focus on learning and development
• An inspiring culture built on innovation, creativity, and freedom.
• Holistic well-being
• Comprehensive range of rewards and recognitions
• Competitive health and medical insurance coverage
• Best-in-class amenities and workspaces
• Policies designed with associates at the center.

EQUAL OPPORTUNITY EMPLOYER

Carelon is committed to a diverse and inclusive workplace and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.

Reasonable Accommodation

Our inclusive culture empowers Carelon to deliver the best results for our customers. We not only celebrate the diversity of our workforce, but we also celebrate the diverse ways we work.

If you have a disability and need accommodation such as an interpreter or a different interview format, please ask for the Reasonable Accommodation Request Form.

Disclaimer: Offered designation titles differ*

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