Clinical Healthcare BPO Consultant (Director Level)

Company Description

Artificial Intelligence. Automation. Cloud Engineering. Advanced Analytics.
For Enterprises, these are key factors of success. For us, they're our core expertise.

We work with global iconic brands. We bring them a unique value proposition through market-leading technologies and business process excellence. At the heart of it all is Digital Engineering - the foundation that powers rapid innovation and scalable business transformation.

We've created 363 unique and independent inventions, 250 of which are AI-based and rolled up under several patent grants in critical technologies. Leveraging our advanced products and platforms, we drive digital transformation at scale, optimize critical business operations, reinvent experiences, and pioneer new solutions, all provided through a seamless "as-a-service" model.

For each company, we provide new keys for their businesses, the people they work with, and the customers they serve. With proven strategies and agile execution, we don't just enable change - we engineer digital outcomes.
Sutherland
Digital Outcomes.
 

Job Description

*For Pooling Purposes*

• Provide consultancy services to the insurance and healthcare vertical to set up the clinical/bill review/insurance practice.
• Establish and maintain communication with clients and/or team members; understand their needs, resolve issues, and meet their expectations.
• Participate in RFPs, client proposals, client meetings & sales calls as directed by the supervisor.
• Produce solid and effective strategies based on accurate and meaningful data reports and analysis and/or keen observations that would impact business outcomes.
• Identify the training needs that will equip the staff with fundamental skills and knowledge for the clinical/bill review/insurance programs.
• Have a thorough understanding of the various system tools and operational procedures utilized within the program and provide guidance/recommendations to the operations team on improving service delivery/outcomes.
• Collaborate with stakeholders on a regular basis for creating strategies.
• Conduct all defined and required process compliance and adherence to all team members, partners, and third-party providers for clinical insurance program and provide recommendations to improve the framework/rectify the identified gaps.

Qualifications

• Earned a bachelor’s degree in any related field.
• Registered Nurse (PH & US Licensed) - required
• At least 15 years of work experience in the same industry with 2-3yrs of Director experience.
• Proven experience in the healthcare/casualty/worker's compensation domain managing processes such as Intake, Clinical Utilization Review, Nurse Reviews, Medical Provider Call Center.
• Excellent working knowledge on Microsoft Office applications.
• Ability to efficiently manage time and keep track of multiple schedules, meetings, and initiatives.
• Strong analytical skills.
• Demonstrated leadership skills.

Additional Information

All your information will be kept confidential according to EEO guidelines.