Senior Vice President of Claims Management

2 weeks ago


Tallahassee, United States Well Care Health Full time

Company Overview: Well Care Health is dedicated to enhancing the well-being of our communities, focusing on individual care for our members.

Position Summary: The Senior Vice President of Claims Management will spearhead a comprehensive organization responsible for the precise, prompt, and effective handling of Medical and Behavioral claims.

Key Responsibilities:

  • Oversee daily operations of the claims departments, ensuring adherence to established regulatory and organizational standards.
  • Formulate the strategic vision for claims processing in alignment with federal, state, and corporate regulations.
  • Manage the claims department to achieve quality metrics and service level agreements.
  • Collaborate with cross-functional leadership to enhance efficiency and prioritize the claims adjudication workflow.
  • Develop and uphold production and quality benchmarks, along with auditing outcomes.
  • Enhance service levels while improving real-time prioritization and productivity capabilities.
  • Establish, assess, and implement processes and procedures to meet the objectives of the organization and departments.
  • Ensure compliance with all relevant state and federal claims payment laws and guidelines.

Qualifications:

  • Bachelor's degree in Business Administration, Management, or Finance; a Master's degree is preferred.
  • A minimum of 10 years of experience in managing and developing claims operations, ideally within a managed care or Medicaid environment.
  • Previous leadership experience, including responsibilities for recruitment, training, task assignment, and performance management of staff.

Compensation: The salary range for this position is $227,000 to $431,900 annually.

Benefits: Well Care Health provides a comprehensive benefits package, including competitive salary, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and flexible work arrangements.

Diversity Commitment: Well Care Health is an equal opportunity employer that values diversity and is committed to creating an inclusive environment for all employees.



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