Director, Claims Modernization, Claims Solution Lead

04 Oct 2024
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Duties & Responsibilities:

Assists in the development of strategic plans to ensure modern and efficient claims processing across the entire lifecycle with a focus on a unified, streamlined experience for both providers and operations staff

Works closely with technology and business leadership to support the evolution and operation of a variety of digital claims capabilities on our modernization roadmap

Analyzes project needs and determines people, process, and technology resources needed to meet objectives and achieve desired outcomes

Ensures the successful completion of current and long-range department goals and objectives and monitors results on an ongoing basis, adjusting plans and performance expectations to achieve targeted performance improvement results

Acts as a liaison between business and technology teams, ensuring accurate translation of ideas and concepts between the parties to align strategy

Takes initiative, thinks analytically, and works independent of supervision as appropriate or needed

Builds, manages, develops, and continuously improves the claims experience to meet the diverse and dynamic needs of a growing, evolving organization

Develops an effective team through hiring, training, coaching, and providing ongoing and constructive feedback

Communicates results to executive leadership using standardized reports, dashboards, and frequent verbal updates through participation in management meetings and operational review processes

Develops, formulates, recommends, and implements decisions regarding policy, standards methods, procedures, and functions

Ensures all NY state and federal compliance, audit and regulatory requirements are met

Performs other duties as necessary or assigned

MinimumQualifications:

Bachelors degree from an accredited institution or equivalent work experience

Prior experience instituting change initiatives within an operational unit

Proven ability to develop strong interpersonal relationships with key stakeholders, with experience communicating and influencing at the senior leadership level.

Successful track record developing creative, workable strategies and tactics to accomplish division, corporate and plan goals

Work experience requiring written and verbal communication that is clear, concise, grammatically correct, and professional

Preferred Qualifications:

Master's degree or MBA from an accredited institution

Prior experience with claims and provider payment operations in a healthcare payor setting

Experience setting departmental strategy, communicating, and influencing impact and progress to senior leadership

Experience with Medicare/Medicaid and Commercial Healthcare

Strong leadership capability with experience leading change, establishing a business strategy, setting performance targets/benchmarks and using metrics, team engagement protocols and innovative problem-solving techniques to drive execution of cost, quality and productivity areas for a large operation

Demonstrated understanding and practical experience using Agile methodologies. Exposure to Scaled Agile (SAFe) preferred

Compliance & Regulatory Responsibilities: Noted aboveLicense/Certification: N/AWE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Full-time
  • ID: #52639466
  • State: New York Hybrid 00000 Hybrid USA
  • City: Hybrid
  • Salary: USD TBD TBD
  • Showed: 2024-10-04
  • Deadline: 2024-12-02
  • Category: Et cetera
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