Senior Director/AVP- US Healthcare (Payer Operations)

About Sutherland:

Artificial Intelligence. Automation. Cloud engineering. Advanced analytics. For business leaders, these are key factors of success. For us, they're our core expertise.

We work with iconic brands worldwide. We bring them a unique value proposition through market-leading technology and business process excellence.

We've created over 200 unique inventions under several patents across AI and other critical technologies. Leveraging our advanced products and platforms, we drive digital transformation, 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. We tailor proven and rapid formulas, to fit their unique DNA. We bring together human expertise and artificial intelligence to develop digital chemistry. This unlocks new possibilities, transformative outcomes and enduring relationships.

Location: Hyderabad / Chennai

Associate Vice President (AVP) of Service Delivery & Account Management in Healthcare Payer BPO acts as the bridge between executive client leadership and large-scale operational teams. This role drives end-to-end service delivery across core Payer domains including :

Claims Adjudication

Member/Provider Services

Enrollment & Billing

Utilization Management, and Provider Data Management while maintaining P&L ownership and expanding enterprise client relationships.

Core Responsibilities:

• Operational Excellence & Service Delivery: Lead multi-site global delivery teams to meet and exceed contractual SLAs, turn-around times (TAT), and quality metrics across US Healthcare Payer lines of business (Commercial, Medicare Advantage, Medicaid, ACO).
• Account Management & Strategic Growth: Function as the primary Client Partner for strategic Payer accounts. Build C-suite and VP-level relationships, drive contract renewals, identify cross-selling opportunities, and lead account expansion strategies.
• Financial Management (P&L): Manage multi-million-dollar portfolio P&L. Optimize margins through resource utilization, automation/AI deployment, right-shoring strategies, and operational cost containment.
• Compliance & Governance: Ensure 100% adherence to CMS guidelines, HIPAA, State Department of Insurance standards, and SOC 2 requirements. Lead client governance cadences (Weekly, QBRs, MBRs).
• Transformation & Innovation: Drive digital transformation initiatives, incorporating automation (RPA), generative AI workflows, and process re-engineering to improve processing accuracy.
• Leadership & Talent Retention: Lead hiring, succession planning, and performance management across delivery teams to minimize attrition in key operational roles.

Domain Expertise

In-depth knowledge of Claims Adjudication, Claims Encounters, Prior Authorization, Member Engagement, Utilization management, and Provider Data Management.

Experience:

20+ years in BPO/ITES with at least 12+ years in Healthcare Payer operations.

Qualification: Graduate, MBA preferred