Job description
Act as Delivery Manager for healthcare Payer TPA Operation and application Support
Managed end-to-end U.S. health insurance operations including
claims processing, provider data management, and member enrollment
Managed activities like claims processing, daily operations including adjudication, denial management, and resubmissions
Ensure compliance with CMS, HIPAA, and payer-specific regulations across all claim processing activities
Collaborated with U.S.-based payers, TPAs, and providers to resolve escalations and enhance service delivery.
Drive client meetings as Point contact for healthcare ay TPA operation and application support
Handle escalated claim issues and coordinate with providers,
payers, and internal departments for resolution.
Tracked project progress, resolved issues proactively, and ensured
deadlines were met with high-quality outcomes
Drive process improvements through enhancing overall efficiency
Work in EST time with client stakeholders and Payer product vendors
Plexis Quantum Choice subject matter expertise is a big plus
Managed end-to-end U.S. health insurance operations including
claims processing, provider data management, and member enrollment
Managed activities like claims processing, daily operations including adjudication, denial management, and resubmissions
Ensure compliance with CMS, HIPAA, and payer-specific regulations across all claim processing activities
Collaborated with U.S.-based payers, TPAs, and providers to resolve escalations and enhance service delivery.
Drive client meetings as Point contact for healthcare ay TPA operation and application support
Handle escalated claim issues and coordinate with providers,
payers, and internal departments for resolution.
Tracked project progress, resolved issues proactively, and ensured
deadlines were met with high-quality outcomes
Drive process improvements through enhancing overall efficiency
Work in EST time with client stakeholders and Payer product vendors
Plexis Quantum Choice subject matter expertise is a big plus
Range of Year Experience-Min Year
12
Physical Location
Bangalore
Qualifications
BE
Range of Year Experience-Max Year
15