Director – Claims Solution Lead – Claims Modernization

Director – Claims Solution Lead – Claims Modernization

Requirements

• Bachelor’s degree from an accredited institution or equivalent work experience
• HS Diploma or GED from accredited institution
• 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

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

Preferred Qualifications

• Master’s degree or MBA from an accredited institution
• Experience with Healthedge specifically with HRP implementation and claims processing
• 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