Billing and Eligibility Leader
EndtoEnd Billing Operations (Professional, Institutional, UB04, CMS1500)
Eligibility & Benefits Verification (Frontend, PreService, PostService)
Revenue Cycle Management (RCM) integration & upstream/downstream controls
Denial prevention, underpayment analysis & revenue leakage mitigation
US healthcare payer rules, CMS guidelines & plan benefit structures
Largescale global delivery leadership
Highvolume transaction management with SLA / TAT / Accuracy governance
Workforce planning, capacity modeling & productivity optimization
Vendor & partner management (BPO / Shared Services)
Performance management through KPIs, dashboards & control towers
YOUR JOB
As a Head of Department, you will hold a management role with accountability for a
large operational function. You will lead multidisciplinary teams (typically supported
by Supervisors/Managers and be responsible for delivering high quality operations,
strong service performance, and a culture of continuous improvement.
The Head of Department owns the strategy, governance, and operational
excellence of eligibility processes, driving accuracy, automation, customer
satisfaction, and cost efficiency. The position requires deep understanding of
healthcare operations, strong leadership, and the ability to transform complex
processes in a high-volume, high-precision environment.
KEY RESPONSIBILITIES
1. Strategic Leadership
Create and execute the departmental Strategy & Roadmap (multi-year plan).
Communicate strategic priorities to stakeholders and ensure teams remain
aligned.
Translate organisational strategy into clear operational objectives and success
measures.
Lead digital transformation, automation, and processreengineering initiatives
to improve accuracy, turnaround time, and customer satisfaction.
Drive a strong performance culture with a focus on innovation, continuous
improvement, and service excellence.
2. Operational Leadership
Lead the day-to-day management of departmental operations.
Ensure productivity, turnaround time, quality, and customer satisfaction targets
are met.
Own the capacity plan for the department, monitoring staffing needs and
proactively addressing risks.
Drive operational discipline, performance management, and continuous
improvement.
Implement global SOPs, KPIs, and operational frameworks for predictable
and scalable delivery.
Optimize resource utilization, productivity, and quality through robust planning
and governance.
Oversee end-to-end enrolment and eligibility operations including policy
setup, membership updates, renewals, endorsements, and group onboarding.
Drive adherence to service levels (SLAs), accuracy targets, turnaround times
(TAT), and process quality benchmarks.
3. People Leadership
Inspire, motivate, and develop leaders and teams across the department.
Provide coaching, performance management, and succession planning for all
management layers.
Promote a positive culture, high engagement, and a collaborative team
environment.
Ensure effective recruitment, onboarding, development, and retention
practices.
Lead, coach, and develop large operational teams, building leadership
capability.
Partner with crossfunctional and global stakeholders to drive integrated
outcomes
4. Change & Innovation
Contribute to organisational transformation initiatives and lead
departmentlevel change.
Identify opportunities to enhance processes, customer experience, and
operational efficiency.
Embed a mindset of innovation, problem solving, and continuous
improvement.
5. Collaboration & Stakeholder Management
Partner effectively with cross functional leaders across Operations and the
wider organisation.
Maintain strong communication channels with stakeholders to ensure
seamless delivery.
Use data insights to challenge performance and drive evidence-based
decision making.
6. Reporting, Compliance & Governance
Produce accurate management information, operational reports, and trend
analysis.
Ensure compliance with risk, audit, and operational governance frameworks.
Quantify and communicate the operational impact of enhancements and
issues.
Ensure adherence to regulatory requirements, audit standards, and internal
controls.
Establish governance mechanisms to mitigate operational, regulatory, and
financial risks.
YOUR PROFILE
Experience
Minimum 20+ years leading large operational healthcare insurance, claims,
enrollment, eligibility operations, or policy administration.
Proven experience delivering complex operational outcomes at scale.
Demonstrable success in people leadership, coaching, and organisational
development.
Strong strategic and operational execution background.
Skills & Capabilities
Excellent communicator with the ability to influence and engage diverse
audiences.
Skilled in stakeholder management across multiple functions and levels.
Highly data driven with strong analytical ability (Excel, BI tools).
Experienced in driving service improvement and customer focused
enhancements.
Strong organisational, planning, and prioritisation skills.
Able to manage ambiguity and lead teams through change.
Skilled in negotiation, problem solving, and process improvement.
Manage operational budgets, cost structures, and financial targets for claims
operations.
Drive costefficiency and improve claims cost ratio.
Behaviours
Results driven, accountable, and committed to achieving shared goals.
Demonstrates flexibility, adaptability, and resilience.
Strong interpersonal skills, fostering trust and collaboration.
Forwardthinking with a continuous improvement mindset.
KEY COMPETENCIES (Band 4 Leadership Level)
Leading leaders
Strategic thinking & roadmap execution
Managing ambiguity
Stakeholder balancing
Organisational savvy
Driving engagement
Building effective teams
Tech savvy leadership
Global perspective
Data driven decision making
