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Sr. Director, Claims Operations - St. Louis

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St Louis, MO
Job Type
Direct Hire
Oct 02, 2018
Job ID

Sr. Director, Claims Operations - St. Louis

Build a best in class claims system - exceptional opportunity for someone who enjoys driving change.  Ideal candidate will have exposure to multiple different claims systems and the ability to act  as an internal consultant within technology and business groups, using quality tools and process definition/improvement to re-engineer technical processes for greater efficiencies.

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

-Partner with multiple stakeholders business unit and health plan leadership to establish operational objectives and procedures

-Oversee implementation of operational efficiencies and development of “best practice” policies and procedures

-Monitor and analyze costs, prepare annual budget and operate department with the budget

-Establish consolidated and consistent processes and relationships with internal and external partners to support the business in achieving its strategic and tactical objectives

-Achieve and maintain all processing and expense standards relating to the Claim Operations

-Collaborate with various cross-functional leaders to identify and execute process improvements and effective initiatives

-Oversee all compliance standards for claims, ensuring operations are actively managing and reducing operational risk

-Oversee change management, and communication and dissemination of critical information to stakeholders, partners, leaders and peers both upstream and downstream

-Assess progress and report statuses to upper management and key stakeholders including timelines and milestones

-Analyze customer impact and respond to complex escalated customer service issues to ensure the customer expectations are consistently exceeded



-Bachelor’s degree or equivalent experience

-8+ years of claims operations, project management, process improvement or shared services experience, in a managed care setting.

-Business transformation experience working within a large matrix organization

-Superior knowledge of health care claims adjudication systems including implementation and configuration experience

-Experience managing Enterprise-wide projects (multiple business lines and technologies)

-Ability to develop and revise project plans, budgets, works with users to understand complex problems, identify and resolve complex business and technical issues.

-Knowledge and understanding of Agile project management methodologies, processes, and tools