Claims Assistant Vice President (AVP) in Woburn, MA at Beacon Health Options

Date Posted: 11/10/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Claims Assistant Vice President (AVP) to join our team in either Woburn, MA or Latham, NY! The Claims AVP oversees and executes tactical and strategic business operations that affect Claims and supporting operational departments.  This position is responsible for oversight of claims processing operations using multiple claims platforms.   Responsible to develop on-going process improvements for productivity and quality.  Acts as change agent to bring efficiencies and continuous improvement to claims adjudication, ensuring the best experience for our customers and providers. 

Position Responsibilities:

  • Oversight of multiple claims teams, across multiple lines of business and platforms
  • Ensures compliance with regulatory requirements
  • Monitors staffing levels, performance, and performance guarantees are met
  • Collaboratively develops and implements claims department’s strategic agenda
  • Applies analytical skills to identify trends in claims processing productivity, pend rates, staff turnover cycles, etc.
  • Develops programs and documentation to standardize practices across the Claims Department sites and platforms
  • Executes corporate development plans and strategies
  • Provides expertise to teams to review and adjudicate claims efficiently and accurately
  • Understands and evaluates customer perspectives, needs, and requirements
  • Delivers clear communication to all levels of the organization
  • Develops logistics to meet departmental and corporate needs
  • Integrates best practices for all claims functions and operations
  • Supports end-to-end claims improvements, including improved automation, performance metrics, work distribution workflows, adjudication that supports outbound claim requirements
  • Represents Claims to clients, providers, and external auditors

Position Requirements:

  • Education: Bachelor’s Degree is required, or High School Diploma with 15 years industry experience
  • Relevant Work Experience: 10 years of medical or behavioral health claims experience, including progressive leadership and supervisory/management roles required
  • Knowledge, Skills, & Abilities:
    • Must understand multiple lines of business, including Commercial, Health Plan, Medicare, and Medicaid
    • An understanding of Medicaid funding streams and braided funding is a plus
    • Must understand state Medicaid and CMS regulatory environment
    • Must possess exceptional verbal and written communication skills for all staff levels
    • Must understand multiple operational roles
    • Must have demonstrated leadership abilities, including building staff morale, developing and applying data driven controls, and process improvement
  • Travel: position requires up to 20% travel

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled