Senior Vice President, Claims Operations in Woburn, MA at Beacon Health Options

Date Posted: 4/4/2018

Job Snapshot

Job Description

We are currently seeking a dynamic Senior Vice President, Claims Operations to join our team. 

The SVP, Claims Operations will report to the Chief Operating Officer and will be accountable for setting and driving strategic direction and providing executive leadership and management to the Benefit and Claims Operations Organization, focusing on ensuring the department's performance meets or exceeds customer expectations while concurrently driving operational efficiencies.

This position can be located in either our Woburn, MA or Latham, NY service centers.

Position Responsibilities:

Strategic Planning and Innovation

  • Develops overall strategic vision for Benefit and Claims Operations and communicates/reinforces vision with organization
  • Establishes and enforces organizational goals, policies and operating procedures
  • Identifies and implements on-going improvement initiatives to improve performance for Benefit and Claims Operations
  • Defines annual operating budget for Benefit and Claims Operations and ensures unit operates at or below budget
  • Responsible for defining and refining the end to end claims process and organizational structure

Customer Implementation

  • Collaborates with national and regional leadership to understand and validate customer specifications against system and process capabilities
  • Distinguishes standard vs. custom specifications
  • Enables standardization and scalability through reinforcement of standard product and benefit offerings
  • Implements custom specifications and establishes process to incorporate into standard offering, where applicable
  • Validates customer requirements are implemented per specification and facilitates customer approval process
  • Collaborates with regional leadership to establish service level agreements (SLAs)/performance guarantees, determines mechanism for tracking and reporting progress against SLAs, influences reputation of Claims Operations

Quality Management

  • Establishes baseline, targets and improvement action plan for claims payment integrity prevention and recovery methods
  • Manages end to end process quality, including reconciliation of accumulators and encounter response files
  • Ensures compliance with state and federal laws, regulatory requirements, accrediting agencies, contractual guarantees and corporate policies and procedures.

Resource and Performance Management

  • Establishes annual capacity plan; evaluates monthly/quarterly forecast against plan and identifies/implements corrective action as needed
  • Responsible for attracting, retaining and managing leadership talent in Benefit and Claims Operations
  • Manages performance of Benefit and Claims Operations teams through establishment of unit and individual goals, ongoing performance management standards, reward systems, and performance corrective action plans
  • Collaborates with Corporate Communications and Training Departments and other departments, as appropriate, to develop, maintain, and execute ongoing Claims communication and training strategies  

Stakeholder Management

  • Develops positive and constructive relationships with key internal and external stakeholders
  • Provides thought leadership to cross-functional leaders on impacts to and from Benefit and Claims Operations and shares recommendations to resolve (e.g., Information Technology, Product, Network, Provider Data, etc.)

Position Requirements:

  • Education:  Master’s degree preferred
  • Relevant Work Experience:
    • Candidate is expected to have a minimum of ten to fifteen years’ previous experience managing personnel and providing formal and informal performance feedback; experience building and managing to key performance indicators a plus.
    • Proven experience in leading/managing large healthcare operation (200+ associates) in claims processing/adjudication, adjustments, payment integrity, benefits, medical policy and other claims-related functions.
    • The appropriate applicant will have high level tactical and strategic experience with demonstrated success in developing and executing on highly visible and sensitive organizational initiatives.
    • Behavioral Health claims experience preferred.

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