Role OverviewThe Operations Manager will lead and oversee teams managing Medicare enrollment, eligibility, and claims operations for U.S. healthcare clients. This role ensures high-quality delivery, process compliance, productivity optimization, and effective stakeholder communication. The ideal candidate has strong U.S. healthcare domain expertise, hands-on leadership experience, and the ability to manage large teams in fast-paced environments.Key ResponsibilitiesOperations LeadershipLead and manage teams handling Medicare/Medicaid enrollment, eligibility verification, and claims processing.Ensure daily operational targets for productivity, quality, SLAs, and turnaround times are consistently met.Oversee end-to-end workflow management including work allocation, monitoring, and performance tracking.Implement best practices to improve accuracy and reduce operational defects.Domain Expertise – Medicare & MedicaidDeep understanding of CMS guidelines, enrollment processes, and claims lifecycle.Provide subject‑matter guidance on Part A/B/D, Advantage plans, Medicaid eligibility rules, and state-specific policies.Monitor CMS updates and ensure compliance across the team.People & Performance ManagementLead a team of 20–60+ associates/analysts (depending on volume).Conduct performance reviews, coaching, and skill‑building sessions.Manage team hiring, onboarding, training, and succession planning.Drive a culture of accountability, continuous improvement, and employee engagement.Client Interaction & Stakeholder ManagementServe as primary operational point of contact for U.S. clients and business partners.Participate in governance calls, present performance dashboards, and manage escalations effectively.Translate client expectations into operational workflows and deliverables.Process Improvement & ComplianceEnsure adherence to CMS, HIPAA, and organization compliance standards.Identify automation/optimization opportunities and lead improvement initiatives (Lean/Six Sigma preferred).Conduct root-cause analysis for defects, escalations, and audit findings.Reporting & AnalyticsPrepare daily/weekly/monthly dashboards on productivity, quality, SLA adherence, and workforce planning.Analyze operational trends to make data-driven recommendations.Required Skills & Qualifications8–12 years of experience in U.S. healthcare operations with at least 3+ years in managerial roles.Strong knowledge of Medicare enrollment and claims processes.Experience managing mid to large teams in a BPO/TPA/payor setup supporting U.S. clients.Familiarity with CMS regulations, eligibility guidelines, and claims adjudication workflows.Excellent leadership, communication, and client management skills.Ability to work in US shifts and manage cross‑functional stakeholders.⚠️ Disclaimer: Firstsource follows a fair, transparent, and merit-based hiring process. We never ask for money at any stage. Beware of fraudulent offers and always verify through our official channels.
Job Title
Operation Manager - Medicare Enrollment