Evolent Health Hiring For Supervisor, Claims at Pune, Maharashtra Full Time

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely – about 40% in year-over-year revenue growth in 2018. Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and one of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:
Manage supervisors, monitor team performance, and monitor operational deliverables for the team.

Manage relationships between stateside counter parts for smooth performance of the team as well to achieve the company wide goals.

Monitor workload fluctuations and adjust staff assignments accordingly both directly and by coaching supervisors.

Responsible for management and oversight of the Claims/Enrolment Department to ensure timely adjudication of claims/updating members records for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met timely and efficiently in accordance with regulations and client guidelines.

Should be having experience of Benefit and Pricing configuration logic

Manages a multi-functional unit of claim professionals/Enrolment associates and support staff.

Leads claim/Enrolment team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality.

Consistently monitors workflows to maximize accuracy and efficiency. Maintains an acceptable level of service and customer satisfaction and retention.

Effectively manages the quality review process.

Develops unit goals, objectives, processes, procedures and systems.

Stays abreast of changes in health plan benefit and pricing methodologies.

Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service. Mentors employees and develops career paths with growth opportunities.

Participates in development of annual departmental budget, monitors budget and identifies budget discrepancies. Research cause of discrepancies and makes recommendations.

Facilitate periodic project tracking to management as needed

Validate and ensure departments compliance to company requirements

Participates in special projects and serves on committees as needed.

Academic Qualification

Associate or bachelor’s degree preferred