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Director, Insurance

1 month ago

Somerset, United States Demant Full time

Overview:
Oticon Medical is a Hearing Implant company providing solutions for those with hearing losses that a hearing aid cannot treat. The Director of Insurance is responsible for the direction and oversight of the Insurance team and acts as the office manager for all the inhouse teams. The director is accountable for delivering a best-in-class customer experience from the insurance team.

**Responsibilities**:

- Develops a culture, procedures and policies that lead to a best-in-class customer experience with focused health insurance acumen.
- Responsible for the strategic intent and operations of the call center with deliberate market functionality.
- Acts as the anchor for New Jersey site staff, modeling expectations for Oticon Medical colleagues and monitoring adherence to overall policies. a
- Collaborates with the relevant commercial and clinical groups within Oticon Medical to maximize coverage and reimbursement for all current and future products.
- Drafts, implements, and executes policies and procedures to facilitate a quality and compliant customer experience.
- Establishes service levels and requirements for the department including role-based performance metrics.
- Develops and implements methods to record, assess, and analyze customer feedback.
- Manages direct reports and will be responsible for their performance and development
- Understands the healthcare and Medicare/Medicaid/private insurance environments, and tracks changes that can affect future reimbursement and policy expansion.
- Proactively identifies, assesses and communicates key policy, reimbursement and contracting issues (including utilization management and prior authorization)
- Leads an internal Insurance Services team through referral/order receipt, medical record review, benefits investigation, pre-authorization approval and denial appeals and claims preparation and submission.
- Coordinates claims/enrollment/collections with other departments within the company.
- Develops and implements training and quality assurance programs for new hires and experienced employees.
- Identifies and recommends expansions to technology, equipment, and policies that may improve service and retention.
- Acts as a liaison between the insurance and customer service department and other divisions in the company.
- Drafts, implements, and manages the department’s budget.
- Holds oneself and others accountable to conduct business in a manner compliant within Oticon Medical’s Code of Conduct, policies and procedures and internal controls applicable to their role.
- May perform miscellaneous tasks/projects as directed by manager.

Qualifications:

- 7+ years of experience in Insurance/Reimbursement (DME preferred) and prior management experience
- Bachelor’s degree required; advanced degree preferred.
- Expert knowledge of reimbursement, government/commercial payer requirements (Medicare, Medicaid, Commercial, VA, etc). Process-oriented with strong analytical and problem-solving skills.
- Experience working in customer-facing roles
- Excellent verbal and written communication skills.
- Excellent interpersonal and customer service skills.
- Excellent organizational skills and attention to detail.

The Company is an Equal Opportunity / Affirmative Action employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

LI-RW1 #OTM

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