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Director of Claims Operations

2 months ago

Renton, Washington, United States Providence St. Joseph Health Full time
Executive Director of Claims

Providence St. Joseph Health seeks a seasoned leader to direct and manage the delegated claim operations, ensuring compliance with regulatory requirements and driving operational efficiency.

Key Responsibilities:
  • Lead the liability claim organization, overseeing all liability lines, including hospital professional liability, general liability, cyber liability, D&O, employers liability, and managed care.
  • Develop and implement optimal claim models and strategies, leveraging digital and data-driven approaches to drive efficient workflows and processes.
  • Ensure compliance with relevant regulations, including state and federal reporting, and develop operational strategies to drive efficient, low-touch, and accurate reporting capabilities.
  • Drive effective claim strategies, including effective management of pre-suit and litigated large loss and severity claims.
  • Ensure sound financial management practices, including effective reserving and settlement strategies.
  • Identify training needs and lead the production of tailored training and development resources for claim professionals and leaders.
  • Partner with shared services leaders and risk managers across the ministries to understand needs and support effective knowledge sharing and collaboration to manage risk.
  • Develop, monitor, and report key measurements and trends to leadership.

Requirements:

  • Bachelor's Degree; or equivalent education/experience.
  • Master's Degree, or J.D. (preferred).
  • 10 or more years of experience with responsibilities in high-volume transaction processing, information interpretation, presentation, and application to internal and inter-departmental efficiency.
  • 8 years of proven leadership ability to interact at and communicate to all levels of an organization.
  • Expertise includes delegated medical group functions, management, and analysis.
  • Must possess excellent oral and written communication, and computer skills encompassing various software applications.
  • Working knowledge of change and transition management and the creation of programs and processes to maximize efficiency and support company goals through transitions.
  • Maintain effective and professional relationships with hospital and health plan partners.