Associate Vice President, Operations

This position is preferred to be based in Massachusetts, Rhode Island, Maine, or Connecticut.

This position directs and manages a broad suite of Operations functions administering benefits for a large commercial market. Together with the VP of Operations, the AVP of Operations is accountable for the collective achievement of superior operational performance of 250 employees supporting over 2.5M members in a commercial line of business. The AVP is directly responsible for positive performance and financial outcomes across utilization management, customer service, claim processing, provider data and credentialing, complaints, grievances and appeals and client engagement. The AVP will focus on building strong communication channels between the operational teams and the client, groups, and brokers.

Qualifications

• Ability to travel, when necessary
• Prior experience in healthcare operations
• Excellent data analytics and problem-solving skills
• Ability to actively participates in the development and implementation of corporate strategic plans and focusing on their tactical implementation
• Self-managed in an autonomous environment
• Knowledge of business projects and concepts through direct assistance and management
• Prior experience in client relations management
• Ability to manage project resources that do not have a direct reporting relationship
• Ability to prioritize and organize multiple tasks and manage competing priorities
• Demonstrated achievements in project management leadership
• Ability to manage multiple priorities and adapt to changing conditions
• Technology acumen required
• Ability to work well with others at all levels of the organization
• Strong presentation skills
• Demonstrated ability to manage high volume transactions in a production environment
• Bachelor’s Degree required
• Excellent communication skills written, verbal and interpersonal
• Proven business acumen
• Ability to present and interact with clients regarding all operational aspects of DentaQuest

Responsibilities

• Define and establish departmental strategies and long-range goals
• Other duties as assigned
• Monitor turnaround times, call statistics, and quality of department functions essential to meeting or exceeding contractual obligations
• Monitor the performance of sub-delegated outsourced functions, manage the partnerships, and evaluate vendors’ performance for continued alignment with operational priorities
• Monitor and implement business quality controls to include measurements, metrics, and improvement opportunities for commercial functions
• Develop and implement strategic business plans that meet or exceed enterprise goals and objectives
• Direct departmental activities to achieve goals that meet business and profitability growth objectives
• Lead management team that performs organizational quality & process analysis; developing & executing plans to improve operational accuracy, compliance & efficiency
• Recognize and promote diversity in all aspects of resource management
• Perform as a data-driven leader exceling at evaluating performance gaps and process inefficiencies, driving results through a highly skilled leadership team, and implementing workflow and technology solutions that meet contractual and regulatory requirements and exceed commercial client SLAs
• Partner with the Vice President, Operations to effectively implement change processes to operationalize the tactical direction of the commercial business
• Manage and direct the strategic and tactical operations for clinical predeterminations and claim processing, provider credentialing and data management, complaints grievances and appeals and customer service
• Participate in the development of corporate strategic plans and focus teams on their tactical implementation
• Maintain positive and professional relationships with key account clients
• Define and establish departmental strategies and long-range goals
• Ensure company compliance with contract service levels and regulatory guidelines and requirements
• Provide leadership and oversight, ensuring the establishment of best practices and management of operations to achieve targeted budgets and metrics
• Provide leadership and oversight, ensuring the establishment of best practices and management of operations to achieve targeted budgets and metrics
• Responsibility for compliance of the commercial program in accordance with applicable contractual and regulatory guidelines
• Motivate staff through effective management and delegation and by formulating and administering policies
• Ensure company compliance with contract service levels and regulatory guidelines and requirements