Staff VP Claims Operations

3 weeks ago

Palo Alto, United States Elevance Health Full time

Anticipated End Date: 2024-12-15

Position Title: Staff VP Claims Operations (Original Claims)

Location: Successful candidate must reside within 50 miles of an Elevance office and be able to work a hybrid work schedule (3 days in office).

Summary: Responsible for the strategic and operational business needs of original claims, or first-time claims, for the Government Business and Commercial Division to include claims adjudication, payment disputes, and adjustments that meet all compliance and regulatory requirements.

Team Scope: 7 direct reports / ~1000 FTE’s

Position Responsibilities:

  • 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.
  • Manages special projects and oversees budget.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Position Requirements: Requires a BA/BS in business administration or a related field and a minimum of 10+ years of management experience in claims that includes adjustments in the managed care and/or insurance industry, experience driving AI/RPA initiatives and transformations; or any combination of education and experience which would provide an equivalent background. MBA preferred.

Preferred Skills, Capabilities and Experiences:

  • Experience implementing digital, AI, or other operational improvements leveraging advanced technology solutions.
  • Experience having accountability for performance of large-scale claims operations.
  • Experience managing large teams (500+).
  • Demonstrated track record of generating ideas and executing with technology partners.

Salary Range: For candidates working in person or remotely in the below locations, the salary range for this specific position is $171,360 to $342,720.

Locations: California; Colorado; District of Columbia (Washington, DC); Hawaii; Jersey City, NJ; Nevada; New York; Washington State.

Benefits: In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Job Level: Staff/Regional VP

Workshift:

Job Family: CLM > Claims Support

Who We Are: Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work: At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates.

Equal Employment Opportunity: Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or any other status or condition protected by applicable federal, state, or local laws.

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