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Executive Director of Customer Service and Claims

2 months ago

Meridian, Idaho, United States Bcidaho Full time
{"title": "Vice President - Customer Service and Claims", "description": "Job Summary

Blue Cross of Idaho Health Service is seeking a seasoned executive to lead our customer service and claims operations. As a key member of our executive staff, you will provide strategic direction and leadership to our customer service and claims teams, ensuring exceptional service to our customers and compliance with regulatory requirements.

Key Responsibilities
  • Provide leadership and coaching to the customer service and claims leadership teams, fostering a culture of accountability, professional development, and high-performance.
  • Ensure fair, accurate, consistent, and timely processing of claims in compliance with member policies, provider contracts, and government regulations.
  • Work closely with leadership and front-line staff to identify areas for process improvements and efficiency enhancements, promoting a culture of continuous improvement within the department.
  • Develop and define processes, workflows, methods, tools, training, and expected outcomes to support effective practices.
  • Ensure all inquiries regarding claims status, benefits, and eligibility are answered accurately, timely, and with excellent customer service.
  • Participate as a member of the executive staff to support effective corporate-wide operations.
  • Enhance technology solutions to ensure accurate and timely processing of claims while improving auto-processing rates.
  • Establish division objectives aligned with company goals and produce regular status reports.
  • Prepare and manage the department's operating budget, controlling expenditures within approved budgets.
  • Approve personnel actions such as hiring, disciplinary actions, termination, and salary recommendations.
  • Promote teamwork, discussion, cooperation, and a respectful and diverse workplace.
  • Develop and maintain departmental policies and procedures.
Requirements
  • Minimum of 10 years of progressive leadership experience in customer service and claims within healthcare insurance operations.
  • Formal leadership experience leading multi-level teams.
  • Healthcare operations experience.
  • Experience in government programs, including Medicare, Medicaid, and Qualified Health Plans.
  • Bachelor's Degree in business or healthcare administration or related field; or equivalent work experience.
  • Master of Business Administration (MBA) or related field preferred.
  • CMS Compliance experience preferred.
  • Strong strategic problem-solving skills with a proven track record of exercising initiative, judgment, and discretion.
  • Ability to translate data and metrics into measurable recommendations.
  • Working knowledge of contact center and healthcare information systems.
  • Ability to build relationships, collaborate, and motivate teams to achieve results.
  • Proficient in effectively managing tasks with multiple opposing priorities.
  • Excellent interpersonal verbal and written communication skills.
  • Strong executive-level presentation skills.
  • Advanced working knowledge of Microsoft Office suite.
About Us

Blue Cross of Idaho is a mission-driven organization committed to delivering exceptional service to our customers and collaborating with top employers across the state. We offer a comprehensive benefits package to support our employees' well-being and provide tools and resources to help them grow professionally. We also encourage our employees to give back to their communities through volunteering and being active participants in community initiatives.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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