AVP - Claims handling (US Healthcare)

About the Role

We are hiring an accomplished

AVP – Claims Operations (US Healthcare)

to lead and transform large-scale claims operations, elevate service delivery, and drive innovation across a major healthcare BPM setup.

The role oversees multi-location delivery teams, partners with global stakeholders, leads automation and analytics-driven transformation, and manages a portfolio of USD 10–20M. This is a high-impact leadership role reporting into the senior operations leadership team.

Key Responsibilities

Strategic & Operational Leadership

Lead end-to-end US Healthcare Claims Operations to industry-leading standards.

Manage large-scale back-office claims functions including PI, SIU, Rework, Enrollment, Coding, Product Build, etc.

Drive automation, RPA, analytics, and transformation initiatives.

Manage P&L, budgets, revenue optimization, cost control, and workforce planning.

Client & Stakeholder Management

Act as the primary operations leader for client engagement, reviews, and performance governance.

Present insights, solutions, and recommendations for business growth and value creation.

People Leadership

Lead a span of 800+ FTE across multiple locations.

Drive performance management, succession planning, training, and employee engagement.

Governance & Compliance

Ensure adherence to HIPAA, ISO, and internal audit / compliance requirements.

Own SLA delivery, quality metrics, audits, and performance scorecards.

Ideal Candidate Profile

18–20+ years of experience in Healthcare BPM with

10–12+ years in US Healthcare Claims Operations .

Proven experience managing large delivery teams and multimillion-dollar portfolios.

Strong domain knowledge of the claims lifecycle and payer operations.

Demonstrated expertise in transformation, automation, and service delivery excellence.

Strong communicator, influential leader, and solution-oriented thinker.