Director, Operations Management

1 week ago

Canton, Ohio, United States Point32Health Full time
Job Summary
Under the general direction of the Director, Appeals & Grievances, this role is responsible for overseeing the overall management of member appeals and grievance processes across responsible lines of business. The successful candidate will ensure compliance with regulatory requirements, facilitate internal and external contributions to case reviews, and lead direct supervision of department supervisors and key staff.
This individual will provide technical support, direction, and guidance to ensure staff deliver best-in-class service and resolution of appeals and grievances that meet and exceed customer expectations. They will actively lead the recommendation, development, and implementation of short- and long-term quality service strategies that improve operations and member satisfaction. Key responsibilities include providing leadership and oversight to complex day-to-day operations, creating effective management controls within company systems, continuously assessing and refining processes to optimize operational efficiency, and maintaining compliance with evolving industry standards and regulations.

Responsibilities/Duties
- Provide leadership and oversight to the complex day-to-day operations of the Appeals and Grievance Department
- Create and maintain effective management controls within the company's systems to monitor operational performance, productivity, and adherence to company policies
- Continuously assess and refine processes to optimize operational efficiency, improve team performance, and maintain compliance with evolving industry standards and regulations
- Work closely with other departments to align team objectives with company-wide goals, ensuring seamless collaboration and effective communication across teams
- Monitor quality and production standards by interpreting data and metrics associated with production turnaround times
- Partner with the Appeals and Grievances Program Management Team to ensure compliance
- Collaborate in the overall improvement of business by recommending, designing, and implementing operational changes or enhancements that improve the efficient delivery of appeals and grievances-related information
- Ensure delivery of optimal customer services by working cross-functionally with internal business units and external stakeholders, including physicians, attorneys, and elected officials

Qualifications
- Extensive leadership experience required, including mentoring, and developing associates to support their professional growth and team success
- Strong ethical background and deep knowledge of compliance essential; must have a proven ability to work closely with compliance teams and adhere to regulatory requirements
- Demonstrated success in creating management controls through systems and reporting to ensure operational efficiency and regulatory compliance
- Excellent written, verbal, and presentation skills required; ability to interact with all levels of personnel, along with knowledge of principles and practices of effective supervision
- Effective decision-making abilities, strong communication, and organizational skills
- Work cooperatively as a team member across multiple levels within the organization

Benefits
As part of our comprehensive total rewards program, colleagues are eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company's sole discretion, consistent with the law.

We offer a competitive salary of $120,000 per year, plus an estimated $20,000 annual bonus potential. Benefits include medical, dental, and vision coverage, retirement plans, paid time off, employer-paid life and disability insurance, tuition program, well-being benefits, and a full suite of benefits to support career development, individual and family health, and financial health.

About Point32Health
Point32Health is a leading health and wellbeing organization delivering an ever-better personalized healthcare experience to everyone in our communities.

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