Dir Claims Operations

Job Locations

US-Remote

Our Mission

Our mission is to SAVE AND IMPROVE LIVES BY EMPOWERING HEALTHCARE CONSUMERS.Come be part of remarkable.

Overview

How you can make a difference

We are looking for experienced leader with passion for driving process improvements and strengthening relationships within the team and company. With high level direction set by business unit and organizational senior leadership, this position is responsible for the overall strategic direction and daily operational functions for Claims Operations.  This includes planning, developing and directing all aspects of the organization's claim programs as well as the establishment, implementation and maintenance of service standards.  Ensures that claim handling expectations and service levels are met for multiple, geographically diverse centers.

What you'll be doing

Remarkable 'purple' service to internal and external customers, embracing the feedback provided as a basis for evaluating quality and determining opportunities for investment to maintain and enhance customer loyalty.

• Continuous, sustainable efficiency improvement through investments in customer self-service, automation, process engineering, strategic in/outsourcing and other strategies.

• Provides direction to Claim Operations management team, establishing major functional roles, courses of action and tactical programs that are aligned with strategic long-term division objectives and directly related to the core values of the business.  Provides leadership in the definition and establishment of standards, internal control mechanisms, key performance measures and standard operating procedures across multiple platforms.  Represents and communicates this approach to management and staff.

• Directs and oversees the initial and ongoing evaluation of customer needs and establishment of processes and procedures related to daily Claims Service Administration.  Ensures overall customer satisfaction by supporting and/or promoting continuous improvement of account management, administrative processes, client set-up, ongoing administration, and claims services.  This includes providing support to the sales team in client presentations, site visits, proposals and projects.

• Sets tactical and long-term goals for each team, aligning objectives with targets established by the division's executive leadership team.  Develops metrics related to key business drivers to measure performance and then monitors, assesses and evaluates performance.  Takes action to change the course of direction, including recommending and/or approving changes in plans.  Reports progress and performance to leadership as appropriate and provides feedback to team members on results.

• Regularly reviews the progress and quality level of service operations.  Ensures that questions are addressed, decisions have been acted upon and problems have been resolved.  Directs meetings where necessary toaddress escalated issues and resolve problems.

• Handles and oversees administrative matters concerning the service organization, including preparing and submitting assigned claims budgets for approval.  This position is also responsible for monitoring and controlling budget performance and taking action to implement cost saving strategies where available.

• Determines areas of cost reduction and program improvement where appropriate and modifies strategies, organization of resources and business plans where necessary.  This position has full cost center accountability and specific responsibility for margin targets as assigned.

• Initiates and approves human resource planning, selection and resource allocation activities that support the Claims teams' productivity and effectiveness.  This includes ongoing responsibility for personnel actions,... For full info follow application link.