Claims Manager - US Healthcare Operations

Role Overview EXL is seeking a results-driven and experienced Claims Manager to lead operations within its Repricing and Extended Functions Strategic Team. This is a high-impact managerial role focused on US Healthcare Claims Adjudication, Overpayments, Automation, and end-to-end Operational Strategy. The ideal candidate is someone who can bridge strategic thinking with hands-on execution while driving accountability, quality, and continuous improvement across all programs. Key Responsibilities - Design and implement strategic frameworks, SOPs, workflows, and governance structures for the Repricing and Extended Functions division - Apply deep subject matter expertise in Prepay and Postpay audits, Claims Adjudication, Overpayments, Appeals and Disputes, CMS regulations, and payer-specific guidelines - Lead automation initiatives in collaboration with Technology, MIS, and Product teams to replace high-volume manual processes with scalable digital solutions - Build and maintain dashboards, trackers, and validation frameworks to monitor operational performance - Manage client onboarding, program transitions, process maps, UAT scenarios, and production readiness documentation - Lead and mentor a team of 10 to 30 FTEs, setting clear goals, fostering cross-training, and building a high-performance culture - Act as the primary liaison across Operations, Clinical, Coding, MIS, Technology, and Client stakeholders - Prepare executive dashboards, RCA reports, governance updates, and compliance documentation for senior leadership Required Qualifications - 7 to 12 years of experience in US Healthcare Operations with a focus on Claims, Pricing, or Overpayments - Proven track record in operations management, process transitions, client communication, and automation - Hands-on knowledge of healthcare pricing tools and workflow platform testing including UAT and defect reporting - Strong proficiency in MS Excel, PowerPoint, and process documentation - Prior experience managing teams of 10 to 30 FTEs in a BPO or healthcare operations environment - Must be based in Chennai with the ability to work from the office regularly Why Join Us EXL offers a dynamic and collaborative work environment where you can lead meaningful transformation in the US Healthcare space. This is an excellent opportunity for a seasoned operations professional to drive strategic initiatives, build scalable frameworks, and make a measurable impact at a globally recognized analytics and operations company.

- 7 to 12 years of US Healthcare Operations experience in Claims, Pricing, or Overpayments - Strong knowledge of Claims Adjudication, Overpayments, Prepay and Postpay audits, and CMS regulations - Experience in automation, process transitions, and client stakeholder management - Hands-on knowledge of healthcare pricing tools - Proficiency in MS Excel, PowerPoint, and process documentation - Experience managing teams of 10 to 30 FTEs - UAT and workflow platform testing experience - Strong analytical and problem-solving skills - Based in Chennai with willingness to work from office frequently

- Opportunity to lead strategic operations at a globally recognised company - Collaborative and high-performance work culture - Exposure to automation and digital transformation initiatives - Cross-functional stakeholder engagement at senior leadership level