Claims Director

1 week ago

Nashville, Tennessee, United States CGS Administrators Full time
Job Title

Claims Director - IT and Operations Leader

About the Role

We are seeking an experienced Claims Director to lead our IT and operations teams. The successful candidate will be responsible for providing strategic direction, managing budgets, and ensuring that all contract obligations are met.

Responsibilities
  • Oversight of Claims and Operational Units: Provide management oversight to claims and operational units, ensuring timeliness and quality metrics are met or exceeded.
  • Contract Obligations: Develop and execute a strategic plan to ensure contract obligations are being met, developing and monitoring budgets and resources.
  • Productivity and Quality Measures: Track, monitor, and analyze productivity and quality performance measures to assess adherence to established requirements and contract specifications.
  • Customer Interaction: Direct customer interaction for direction, evaluation, and modification of processes.
  • Technical Oversight: Provide technical oversight and coordination with technical teams, including project management to ensure timely implementation of change requests and technical direction letters.
  • System Operation: Ensure all systems are operational and meet the needs of the MAC contract.
  • Testing and Development: Accountable for directing testing of standard systems release modifications for responsible functional areas and their interfaces with external systems.
  • Data Management: Ensure applicable internal systems files and tables are maintained according to regulations and claims processing procedures.
  • Change Communication: Communicate changes to affected business units.
  • Project Management: Provides project management oversight, guidance, knowledge, and technical expertise for all departments with the MAC contract.
  • Risk Management: Identify potential risks and develop mitigation strategies to ensure project success.
  • Communication: Maintain clear and effective communication with stakeholders to ensure alignment and transparency.
About You

We are looking for a highly skilled and experienced professional with a strong background in claims processing, IT, and operations management. The ideal candidate will have:

  • Education: Bachelor's degree in a job-related field.
  • Experience: 7 years of claims processing experience, including 6 years of system testing, and 3 years of management/supervisory experience, or equivalent military experience.
  • Skillset: Excellent management, communication, analytical, and human relations skills; proficient in provider reimbursement methodologies, budget planning, and monitoring.
  • Software and Tools: Microsoft Office, knowledge of FISS and MCS.
What We Offer

We offer a competitive salary and benefits package, including subsidized health plans, dental and vision coverage, 401K retirement savings plan with company match, life insurance, paid time off, on-site cafeterias and fitness centers, wellness program, tuition assistance, service recognition, employee assistance, and discounts to movies, theaters, zoos, theme parks, and more.

Salary Range

The estimated salary for this role is $120,000 - $160,000 per year, depending on experience.

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