BPM - Claims Operations (FACETS) Lead
Full-time
MSRcosmos LLC
Job Summary
We are seeking an experienced BPM Claims Operations Lead with strong Healthcare Payer, FACETS Claims Processing, and BPM/BPO expertise to lead operational transitions, service delivery, client governance, and continuous improvement initiatives.
Mandatory areas – Claims Operations - 10+ years
Must Have skills:
- FACETS
- Healthcare Systems
- Claims Management
- Stakeholder Management
Key Responsibilities
- Lead end-to-end transition, knowledge transfer, operational readiness, and stabilization of FACETS Claims Operations.
- Manage client relationships, stakeholder governance, operational reviews, and risk mitigation.
- Oversee claims adjudication operations, ensuring SLA compliance, quality, accuracy, productivity, and turnaround times.
- Drive process optimization, automation, standardization, and BPM transformation initiatives.
- Manage onshore/offshore teams, workforce planning, capacity management, and resource optimization.
- Establish performance metrics, reporting dashboards, and operational governance frameworks.
- Collaborate with Enrollment, Provider, Billing, Configuration, and Technology teams.
- Ensure compliance with healthcare regulations, client policies, and audit requirements.
Required Qualifications
- 10+ years of Healthcare Payer Operations and BPM/BPO experience.
- Strong expertise in FACETS Claims Processing and Adjudication.
- Experience leading large-scale transitions, transformations, and managed services engagements.
- Knowledge of Commercial, Medicare, Medicaid, and Government Programs claims operations.
- Proven experience in client management, SLA governance, workforce planning, and operational delivery.
- Experience managing large onshore/offshore teams.
- Strong leadership, communication, stakeholder management, and problem-solving skills.
Preferred Qualifications
- Experience leading Healthcare BPM transformation programs.
- Knowledge of Lean Six Sigma, process excellence, automation, and AI-enabled transformation.
- Exposure to FACETS workflows across Claims, Enrollment, Provider, Billing, and Configuration.
Key Success Metrics
- SLA and KPI compliance
- Claims processing quality and accuracy
- Productivity and turnaround time
- Successful transition and operational stabilization
- Continuous improvement and customer satisfaction
Vacancy posted 3 days ago
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