Claims Operations Manager
Job Code : GEN/1191
Work@HomeJob Description
The Claims Operations
Manager is responsible for the overall business culture and operation of the
site and the development, guidance and direction of claims operations staff.
The incumbent is an experienced and well rounded ?hands on? leader with a focus
on driving operational performance, facility management, P&L and continuous
improvement initiatives. The Claims Operations Manager will have a team of 5 or
more direct reports and will be responsible for up to 200 claims operations
employees.
Responsibilities:
- Direct day to day operations of the claims department
and ensure that claims are processed within client and company guidelines
- Empower the claims leadership team and support the
department and ensure quality claims metrics and service level agreements
are met
- Collaborate with executive leadership from cross
functional departments to ensure efficiency and proper prioritization of
the claims adjudication process
- Provide
regular feedback, support and leadership regarding department level
performance in critical areas such as P&L, KPI, company policy and
procedure adherence, and client and employee satisfaction
- Proactively
create, implement and lead department improvement efforts that produce
successful results in the aforementioned areas
- Meet
profitability goals in the profit center environment
- Establish
and communicate client and internal strategies and key performance
indicators to the healthcare vertical?s management team
- Serve
as an effective business partner to multi-site clients working in
conjunction with peers to achieve mutual goals
- Actively
participate in the site?s Occupational Health and Safety and Employee
Engagement Committees
- Participate
in weekly corporate level senior leadership meetings
- Enhance
department level bench strength by hiring, coaching and mentoring direct
reports; providing career development and professional growth
- Be
an active member of the community and be able to act as a role model
within the company
- Special
projects as assigned
The above statements
describe the general nature and level of work being performed. This is not
intended to be an exhaustive list of all responsibilities and duties required.
Requirements
- The
qualified candidate will possess a bachelor?s degree or equivalent
combination of education and experience
- A
minimum of 5 years of progressive responsibility overseeing
and developing claims operations preferably in a managed care and or
Medicaid setting
- A
strong understanding of Contact Center operations and Contact Center
solutions
- Excellent
leadership and interpersonal skills
- Extensive
experience with all Windows platforms, Microsoft Office, internet, etc
- Able
to work in a 24 hour a day, 365 days per year environment
- Strong
organizational, analytical, leadership, interpersonal and time management
skills
- Flexibility,
versatility and proven ability to lead change
- Strong
fiscal management skills in a P&L environment
- Excellent
verbal and written communication skills
- Strong
facilitation and presentation skills
- Strong
project management and planning skills in order to successfully manage
multiple projects simultaneously
- Strong
knowledge and experience in complex people management
- Demonstrated
leadership over multi-functional departments to include IT, Telephony,
Facilities, Training, Recruiting and HR
- Minimal
amount of travel required
- Clear
criminal record check required