Senior Director, Claims Transformation
St. Louis , MO, USA | Centene Corporation
Industry:Healthcare - Hospitals
Functions:Operations / Production
Job Description:73 people have viewed this job
Direct and oversee the end to end claims process and performance assurance programs across the operations. 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. This role will drive quality, compliance, and efficiency to ensure optimized metrics within the operations organization.
Lead the organization in the development of effective and efficient business processes that will meet or exceed internal and external performance expectations
Develop strategic vision and execution roadmap for quality and process improvement initiatives that establish a culture of quality by participating in long-range planning
Serve as the primary leader and expert regarding the end-to-end claims process
Partner with multiple stakeholders business unit and health plan leadership to establish operational objectives and procedures
Lead the organization in the development of effective and efficient business processes
Oversee implementation of operational efficiencies and development of “best practice” policies and procedures
Provide strategic direction and leadership in developing innovative initiatives to improve overall quality outcomes
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 including the proposal and implementation of new technological tools.
Oversee all compliance standards for claims, ensuring operations are actively managing and reducing operational risk and introducing programs and initiatives to promote positive outcomes.
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
Education/Experience: Bachelor’s degree or equivalent experience. Masters Degree preferred. 8+ years of claims operations, project management, process improvement or shared services experience, preferably in a managed care and/or Medicaid setting. Strong process improvement experience with a keen focus on quality.Previous experience with organizational and strategic business process design and development experience preferred. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff preferred.
Six Sigma Black Belt, Certified Quality Manager, or other advanced quality certification preferred.
Already a member? Sign In