Product Manager- Claims and Provider Lead
Share
Job Location:
Monthly Salary:
Posted on:
Yesterday
Vacancies:
1 Vacancy
Job Summary
InfosysHelix is seekingaProductManager- Claims and Provider Lead for this growing Work stream Leader will provide leadership and operational oversight for the implementation and ongoing operations of Infosys Helix across Claims Provider and A&G functions for Medicare Advantage programs serving US health plans. This role will act as the primary clientfacing leader responsible for ensuring seamless delivery of all Claims Provider and A&G capabilities driving regulatory and contractual compliance and enabling scalable efficient and auditable operational processes across the platform.
Key Responsibilities
The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone email or face to face. Travel may be required as per the job requirements.
About Us
Infosys is a global leader in next-generation digital services and consulting. We enable clients in more than 50 countries to navigate their digital transformation. With over four decades of experience in managing the systems and workings of global enterprises we expertly steer our clients through their digital journey. We do it by enabling the enterprise with an AI-powered core that helps prioritize the execution of change. We also empower the business with agile digital at scale to deliver unprecedented levels of performance and customer delight. Our always-on learning agenda drives their continuous improvement through building and transferring digital skills expertise and ideas from our innovation ecosystem.
Infosys provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy childbirth or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability.
- Oversee endtoend Claims Provider and Appeals & Grievances (A&G) operations for Medicare Advantage ensuring accurate adjudication pricing payments issue resolution and provider data quality.
- Serve as the primary clientfacing leader for all Claims Provider and A&G functions delivered through the Infosys Helix platform.
- Ensure CMS compliance by implementing strong operational controls monitoring regulatory updates and maintaining auditready processes across Claims Provider and A&G workflow areas.
- Lead provider lifecycle management including onboarding credentialing integration directory accuracy network data stewardship and coordination on provider-related A&G matters.
- Drive performance monitoring through KPIs rootcause analysis quality improvements and corrective action planning across Claims Provider and A&G operations.
- Collaborate across Claims Provider Medical Management A&G and compliance teams to deliver a seamless Medicare Advantage operational experience.
- The candidate must belocatedwithin commuting distanceofTempeAZor be willing torelocateto this position may require travelinthe US.
- Bachelors degree or foreign equivalentrequiredfrom an accredited institution. Will also consider three years of progressive experience in the specialty in lieu of every year of Education.
- 7 Yrs of Domain experience (Healthcare).
- 5 years of experience in US healthcare operations including deep expertise in Medicare Advantage regulations CMS compliance requirements and payer operational processes.
- Strong understanding of Claims and Provider operations including regulatory controls audit readiness HIPAA compliance and BPaaS/SaaS healthcare platforms.
- Demonstrated ability to lead cross-functional teams work with clients as a primary liaison and influence stakeholders without direct authority.
- Excellent communication analytical and problemsolving skills with the ability to translate regulatory or contractual requirements into scalable operational processes.
- Medicare Advantage Claims and Provider operation CMS Audits.
- Strong understanding of healthcare payer operations.
- Excellent communication presentation and interpersonal skills
- Ability to influence cross functional teams without direct authority.
- Strong analytical and risk-based decision-making skills.
- Ability to elicit information frommyriadofSMEs (technical & business).
- Ability to providethought leadership and influence to implement strategic methods.
- Excellent and assertivecommunication skills.
- Ability to switch between projects andmaintainconsistency.
- Ability to be a part of a diverse team/ multiple stakeholder environment.
- Working in an agile environment- with Scrum KanbanSAFemethodologies.
- Experience anddesireto work in a Global delivery environment.
- Medical/Dental/Vision/Life Insurance.
- Long-term/Short-term Disability.
- Health and Dependent Care Reimbursement Accounts.
- Insurance (Accident Critical Illness Hospital Indemnity Legal).
- 401(k) plan and contributions dependent on salary level.
- Paid holidays plus Paid Time Off.
The job entails sitting as well as working at a computer for extended periods of time. Should be able to communicate by telephone email or face to face. Travel may be required as per the job requirements.
About Us
Infosys is a global leader in next-generation digital services and consulting. We enable clients in more than 50 countries to navigate their digital transformation. With over four decades of experience in managing the systems and workings of global enterprises we expertly steer our clients through their digital journey. We do it by enabling the enterprise with an AI-powered core that helps prioritize the execution of change. We also empower the business with agile digital at scale to deliver unprecedented levels of performance and customer delight. Our always-on learning agenda drives their continuous improvement through building and transferring digital skills expertise and ideas from our innovation ecosystem.
Infosys provides equal employment opportunities to applicants and employees without regard to race; color; sex; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy childbirth or related medical conditions; status as a protected veteran or spouse/family member of a protected veteran; or disability.
Required Experience:
Manager
Key Skills
- Time Management
- Data Analytics
- Analytical
- Agile
- Requirement Gathering
- Strategic thinking
- Visio
- Communication
- Problem Solving
- Market Research
- UML
- Cross Functional Teams
About Company
Welcome to Infosys Careers for Experienced Professionals As a leading provider of next-generation consulting, technology and outsourcing solutions, we are dedicated to helping organizations in over 46 countries to renew their core and simultaneously innovate into new frontiers. Whilst ... View more
