Role Summary The Black Belt – Manager will lead end-to-end process excellence, quality transformation, and productivity programs across Healthcare Claims operations (Commercial, Medicare, Medicaid, Specialty). The role is responsible for driving measurable business outcomes through Lean Six Sigma, RCA-driven improvements, automation enablement, and cross-functional governance while partnering closely with Operations, Quality, Training, WFM, and Client stakeholders.

1. Transformation & Continuous Improvement

- Lead Lean Six Sigma Black Belt projects across Claims (Intake, Adjudication, Adjustments, Appeals, EDI, Correspondence).
- Drive defect reduction, rework elimination, and cycle time improvement using DMAIC / Lean methodologies.
- Identify and execute high-impact transformation opportunities aligned to business priorities and client KPIs.
- Own end-to-end project lifecycle from problem definition to benefit realization and sustainment.

2. Quality & RCA Leadership

- Conduct deep-dive RCA using People | Process | System | Technology frameworks.
- Lead Pareto analysis, FMEA, trend analysis, and defect heatmaps for escalations, audits, and quality failures.
- Partner with Quality teams to improve OAR, financial accuracy, compliance scores, and audit outcomes.

3. Claims Domain & Client Value Creation

- Apply strong US Healthcare Claims knowledge across Commercial, Medicare, Medicaid, and Specialty lines.
- Work closely with UHG stakeholders to align process improvements with payer policies and regulatory requirements.
- Support client governance, business reviews, client visits,



and escalations with data-backed insights.
- Translate operational improvements into quantified benefits (QNI, BVM, FTE productivity, cost savings).

4. Automation & Digital Enablement

- Identify opportunities for RPA, AI, analytics, and system-led automation across claims processes.
- Collaborate with Automation / IT teams on solution design, deployment, and benefit tracking.
- Drive manual exception reduction and touchless processing improvements.

Required Qualifications & Experience

Education

- Bachelor’s degree (Engineering / Healthcare / Business preferred)

Certifications

- Lean Six Sigma Green Belt (Certified – Mandatory)
- PMP / Agile certification – positive to have
- Any programming / Coding would be an advantage

Experience

- 10–15+ years total experience , with 5+ years in US Healthcare Claims
- Proven experience leading Black Belt–level transformation programs
- Strong hands-on knowledge of:
- Claims adjudication & processing workflows
- US healthcare regulations & payer guidelines
- RCA tools, statistical analysis, and storytelling for leadership/client forums

Skill Set

Core Skills

- Lean Six Sigma (DMAIC, SPC, Hypothesis Testing)
- RCA / FMEA / Pareto / Control Planning
- Claims domain expertise (Commercial / Medicare / Medicaid)
- Data analytics & insight storytelling
- Stakeholder & client management

Behavioural Competencies

- Outcome-driven mindset
- Structured problem solving
- Executive communication & influence
- Strong ownership and accountability
- Coaching & people development

📌 Process Excellence Manager (Navi Mumbai)
🏢 Wipro
📍 Navi Mumbai