Position is located: Mason Ohio, Virginia Beach, VA & Tampa, FL This is no a work from home position or remote location position.
Responsible for developing the claims payment and adjustment strategy in Services Operations. Primary duties may include, but are not limited to: Oversees multiple claims processing units, executes strategies to deliver industry leading service results. Improves processes and partners across lines of business to develop consistency and share best practices. Drives results to improve member/provider satisfaction. Builds strong partnerships with Plan Presidents, collaborates with IT, Enterprise Benefit Administration, Provider Engagement and Contracting, Sales, and Internal Audit. Leads systems consolidation efforts, compliance requirements, and monitors state/federal regulations. Manages special projects and oversees budget. Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requires a BA/BS in business administration or a related field; 10
• years of management experience in claims that includes adjustments in the managed care and/or insurance industry; or any combination of education and experience, which would provide an equivalent background. MBA preferred.
Hiring Managers preferred skillset & experience
- Health Insurance / Payer at larger competitors
- Government - Medicaid and/or Medicare
- Transaction Operations, Claims preferred
- Leadership Depth and Breadth
- Vender / Offshore Leadership – Oversight of vender relationships and operations transition experience preferred
- Quality Audit Programs
SKILLS AND KNOWLEDGE
- Process orientation
- Fact and data based – operates via data; understands how to read and interpret reports and analysis
- Deep understanding of operations/production management – productivity, throughput, capacity planning, forecasting, etc.
- Routine that quickly identifies areas of focus – anticipates and mobilizes action
- Clear, concise, fact based
- Leadership/Executive reporting and messaging
- Appropriate level of detail and positioning for audience
- Appropriately anticipates reactions and questions then minimizes/mitigates unnecessary spin
- Visible and connects with all levels in the organization
- Engages in associate events
- Operates as team versus individual, viewed as a team player