Director, Operations

1 month ago


El Dorado Hills, United States Blue Shield of California Full time

Your Role
 
The Payment Integrity & Corporate Recovery team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context. It encompasses determining the correct party, membership eligibility, contractual adherence, and fraud, waste and abuse detection and prevention. This team is responsible for over $400M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments. The Director of Payment Integrity & Corporate Recoveries will report to the Senior Director, Encounters Performance & Payment Integrity. In this role you will build strong relationships with multiple functions within the overall Blue Shield organization, reduce cost of healthcare risks, and ensure accurate payments resulting in improved cost of healthcare and premium cost outcomes. 
 
Your Work
 
In this role, you will:

Leverage data and operational expertise to set a vision and lead strategies to optimize processes resulting in increased cost of healthcare savings, quality, and administrative cost optimization
Influence relationships and partner with all levels of leadership up to and including the Chief Operating Officer and Chief Financial Officer
Lead a team of dedicated subject matter experts, while providing learning and growth opportunities
Hands-on engagement in evaluation, design, development, and implementation of new products that will improve Blue Shield’s payment integrity performance
Identify novel avenues of pursuit for the improvement of payment accuracy
Manage multiple vendor relationships across multiple disciplines and influence efficiencies resulting in cost savings and increased effectiveness
Build and execute strategies and business cases as necessary to realize critical opportunities
Build and develop a high performing team measured by key performance indicator results

 Your Knowledge and Experience 

Requires a bachelor’s degree or equivalent experience
Requires at least 10 years prior relevant experience, including 6 years of management experience
In depth experience with payment integrity practices and related operations required
Healthcare Insurance payment integrity experience required
Possess strong data/analytic, financial, and process experience
Experience building new business capabilities
Strong prioritization capability and strategic approach
Strong experience building high performing teams
Strong communication and relationship building skills

 
Pay Range:
 
The pay range for this role is: $ 155,500 to $ 233,400 for California.
Note:
Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
 
 
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