Role description
Job Description: BPO Manager - Healthcare 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 or supervisory 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, E&B, 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 12-18 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 Product Configuration / Group Setup Clinical - UM/CM/Risk Adjustment 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)
Skills
BPO, Healthcare, ITSM, Program Management, Test Automation
About UST
UST is a global digital transformation solutions provider. For more than 20 years, UST has worked side by side with the world’s best companies to make a real impact through transformation. Powered by technology, inspired by people and led by purpose, UST partners with their clients from design to operation. With deep domain expertise and a future-proof philosophy, UST embeds innovation and agility into their clients’ organizations. With over 30,000 employees in 30 countries, UST builds for boundless impact—touching billions of lives in the process.
