Director - Claims

Responsibilities:

Determine the Claims Department operational strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses, identifying and evaluating technology, productivity, quality, and service standards, contributing information and analysis to organization strategic plans and reviews.Collaborates across the organization to define the customer journey and recommend process improvements to improve the overall customer experience.Maintains and improves claim operations by monitoring system performance, claim inventory levels, team performance, identifying and resolving problems, preparing, and completing action plans, managing systems, process improvements and quality assurance programs.Develops deep technical knowledge of all claim systems and collaborate with IT to ensure the highest levels of automation and CX.Accomplishes Claims Department people objective through ensuring strong recruiting, training, coaching, and development of all levels of associates.Responsible for creating an environment of inclusivity, recognition, and teamwork to ensure employee engagement and alignment with company values and objectives.Prepares Claims Department reports by collecting, analyzing, and making recommendations based on data and trends.Maintains professional and technical knowledge by tracking emerging trends in Claims Operations, attending education workshops, reviewing profession publication, establishing personal networks, benchmarking state-of-the art practices and participating in professional societies.Manage all vendors to ensure superior performance and value is returned to GeoBlue.Develops and maintains a collaborative partnership with stakeholders across the organization.Other duties as assigned.
Requirements:

Bachelor's degree and 5-10 years of healthcare claim operations leadership experience required.Demonstrated leadership skills are required to manage, to motivate and to develop high performance work team; employee development, performance management, training, and employee counselling are essential to this role.Strong analytical and negotiation skills.Ability to think strategically and articulate vision.A passion for continuously improving customer experience.Experience in a Blue Cross Blue Shield Plan is a positive.Excellent listening, verbal, written, and telephone etiquette, as well as business communication skills.

Strong facilitation, investigative, analytical & problem solving, and organization and time management skills.Proficient with Microsoft Office Products SFDC experience a plus.Must possess a positive, can-do, and teamwork attitude.Employee is required to have at minimum an internet speed of 75 Mbps (standard high-speed internet access).
Working Conditions:

Flexibility to work in an office and/or at-home, remote office environment.Schedule flexibility is occasionally necessary in this position. Individual may be required to attend key business/departmental meetings and/or perform certain business critical job functions outside of normal working hours. Physical Demands: Must be able to communicate internally and externally through receiving and responding to auditory and visual methods.Travel required on occasion dependent on business needs.
Internal Pay Grade: 14

The starting pay for this role is $121,044 to $160,383 based on skill level and experience in a similar role.

This job description reflects management's assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.

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