Workstream /Healthcare Operations Lead - Medicare Advantage Operations

Job Description:
The Work stream Leader will provide leadership and operational oversight for the implementation and ongoing operations of client across Claims, Provider, and A&G functions for Medicare Advantage programs serving US health plans.
This role will act as the primary client‐facing 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.

Must Have Skills
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, root cause analysis, quality improvements, and corrective action planning across Claims, Provider, and A&G operations.

Minimum years of experience
8-10 years

Top 3 responsibilities you would expect the Subcon to shoulder and execute
Oversee end to end 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 client facing 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 audit ready processes across Claims, Provider, and A&G workflow areas.

Nice to have skills
Medicare Advantage Claims and Provider operation, CMS Audits
Strong analytical and risk-based decision-making skills.