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Director of Operations

3 months ago

Meridian, Idaho, United States AHU Technologies Inc Full time
Organization is seeking a highly skilled and experienced Director, Claims to join our team in Meridian, Idaho. As the Director of Claims, you will have overall responsibility and accountability for all aspects of healthcare claims operations.

You will play a critical role in assuring timely and accurate benefit determinations for claims, while maintaining high service levels for our valued members and providers.

This is a unique opportunity to make a significant impact and drive positive change within our organization.

Responsibilities:
Apply your vast experience to integrate diverse components of cross-functional business decisions and consistently enhance claims processes and procedures.
Develop strategies, implement, lead, and champion quality process excellence and compliance requirements.
Establish and maintain a system that evaluates claims performance and the customer experience.
Identify areas for improvement, create action plans, provide guidance to team members, and ensure goals are met.

Requirements:
10 years of claims operations experience within the health insurance industry, including management experience
Bachelor's Degree in Business or Healthcare Administration preferred, or equivalent work experience
MBA (preferred).
CMS certification (preferred).
Knowledge of FEP benefits and pricing
Experience with claims processing systems, including Facets
Experience leading teams that excel in collaboration and achieving results
Experience in inventory management and reporting
Knowledge, Skills, and Abilities (KSAs) needed in this role:

Knowledge of:
Components and principles of management production control
Accounting principles
Data processing management information system that affect claims processing
Business budgeting processes
Forecasting and planning techniques
Health insurance contract benefits and provisions
Health insurance provider pricing and networking

Skills:
Strong collaboration and discernment
Strong people leadership experience
Excellent verbal and written communication
Excellent motivational and staff recognition
Proven management and leadership skills in a team-based environment
Creative and analytical thinking
Analytical and decision-making
Proficient in Microsoft Office - Word, Excel, Outlook, and PowerPoint

Ability to:
Collaborate with others to obtain effective working relationships and outcomes
Be flexible and creatively respond to operating and system challenges
Work with employees at all corporate levels
Communicate effectively with members, providers, and other Blue Cross and Blue Shield Plans
Manage multiple priorities and daily diverse activities
Analyze and recommend process improvements for business operations
Participate in and/or deliver presentations or discussions to a wide variety of internal/external audiences, such as sales presentations to important accounts

Your Day-to-Day:
Assure cost-effective high service levels to members and providers through fair, accurate, consistent, and timely claims processing
Assure that national and corporate standards are met for timeliness and accuracy in claims
Represent Claims operational perspective in the development of corporate business rules
Assure effective communication with department, division, and corporate levels of management
Assure that department management information systems, core claims and benefits processing systems, and reporting capabilities are accurate and up to date
Assure effective development and implementation of corporate initiatives and projects
Establish department objectives that support company goals and produce regular status reports
Prepare an operating budget that reflects the forecasted needs of the department and control expenditures
Ensure effective workflows, improve system efficiencies, and monitor quality performance measures
Initiate personnel actions such as hiring, disciplinary actions, and salary recommendations
Promote teamwork, discussion, and cooperation among staff and other departments
Develop and maintain departmental policies and procedures
Direct the design, planning, and implementation of training programs aligned with operational objectives and strategies
Collaborate with functional management to assess ongoing and future training and development needs
Approve new training techniques and suggest enhancements to existing training programs
Oversee and establish relationships with vendors to provide additional outside training programs
Perform other duties and responsibilities as assigned.

Job Type:
Full-time

Pay:
From $140,000.00 per year

Work setting:
Remote

Work Location:
In person

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