Deputy Manager/ Manager - Payer Claims

Position Overview:
MDI NetworX is seeking a Deputy Manager / Manager Payer Operations to oversee end-to-end healthcare payer processes, drive operational excellence, and ensure compliance with US healthcare standards. This leadership role requires expertise in process optimization, stakeholder management, and team development

Key Responsibilities:

• Lead and manage payer operations, ensuring efficiency and quality in service delivery.
• Develop and implement strategies to optimize claims processing, enrollment, and provider data management.
• Drive team performance, coaching, and professional development initiatives.
• Conduct salary negotiations and oversee talent acquisition for the department.
• Ensure compliance with HIPAA, ACA, and other payer regulations.
• Manage escalations, resolve critical process issues, and implement continuous improvement initiatives.
• Collaborate with senior leadership, clients, and cross-functional teams to enhance operational effectiveness.
• Monitor key performance indicators (KPIs) and generate actionable reports.

Required Skills & Qualifications:

• Bachelors degree or equivalent experience.
• 8-12 years of experience in US healthcare payer operations.
• Strong expertise in claims adjudication, enrollment, and provider data management.
• Proven experience in leadership, stakeholder management, and process optimization.
• Proficiency in MS Office, healthcare payer systems, and data analytics.
• Excellent strategic thinking, communication, and problem-solving skills.

Preferred Qualifications:

• Experience with Medicare, Medicaid, and commercial payer processes.
• Knowledge of EDI transactions (837, 835, 834).
• Prior experience in a BPO or shared services environment