Vice President, Operations

Required Experience

• 7-10 Years leading Claims Department Operations for Managed Care Organization in either Director or Vice President level capacity.
• Ability to communicate effectively with team members, colleagues, and Executive Leadership in verbal and written form.
• Experience serving Medicare Advantage, Managed Medicaid, Duals, Exchange, and other Government Program Members.
• Must be able to travel weekly. Monday-Thursday (Remote Fridays)
• Prior Consulting Experience (Preferred)

Role & Responsibilities

• Develop the vision and goals for the claims department in compliance with federal, state and Company guidelines
• Oversee and ensure achievement and maintenance of all claims processing standards within established guidelines

• Partner with multiple business units, health plans and other stakeholders to establish operational objectives and procedures.

• Identify business needs and drive change initiatives to address these issues

• Ensure all issues are resolved accurately and timely and implement action plans to address any issues
• Identify and implement operational efficiencies and development of “best practice” policies and procedures
• Analyze customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met

• Direct the day-to-day operations of the claims department and ensure accurate and timely processing of members medical claims within established state and company compliance guidelines.

Job Type: Full-time

Salary: $160,000.00 to $220,000.00 /year

Experience:

• Health Plan: 5 years (Required)
• Operations Management: 7 years (Required)

Work Location:

• One location

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Retirement plan
• Paid time off

This Job Is Ideal for Someone Who Is:

• Dependable — more reliable than spontaneous
• People-oriented — enjoys interacting with people and working on group projects
• Adaptable/flexible — enjoys doing work that requires frequent shifts in direction
• Detail-oriented — would rather focus on the details of work than the bigger picture
• Achievement-oriented — enjoys taking on challenges, even if they might fail
• Autonomous/Independent — enjoys working with little direction
• Innovative — prefers working in unconventional ways or on tasks that require creativity
• High stress tolerance — thrives in a high-pressure environment

Schedule:

• Monday to Friday