Director, Claims Operations Jobs

Responsible for the development and execution of claims operations strategies; end-to-end claims process automation, optimization and management; and leveraging technology and data to improve quality and minimize cost of processing claims for all clients across Magellan. Provides leadership and development of the Claims department and collaborates with executives and other departmental leaders to effectively process and pay claims from providers and facilities in a timely manner and in compliance with customer requirements, performance guarantees, federal and state regulations, and Magellan policies. Affords the opportunity to create a lasting footprint by developing and implementing strategies around Claims that align with and support Magellan’s overall goals and objectives. Responsible for continuous process improvement and standardization around planning, implementation, and controls for the Claims Operations department.

• Evaluates departmental processes; determine process changes based on process analysis and determined outcome to make continuous improvement of claims department, work processes, and operating procedures in relation to key performance objectives.
• Collaborates with all departments within the company relating to claims innovation, quality, and process improvement to drive best practices and knowledge sharing.
• Keeps abreast of any changes to legislation and regulations which pertain to claims processing. Partners to modify and/or develop internal policies and procedures to ensure operations remain in compliance.
• Establishes an effective matrixed partnering relationship with service centers and corporate departments.
• Represents Service Operations on the Client's Joint Operations Committeect (JOC) by coordinating and directing tasks necessary to complete all related action items.
• Ensures claims operation is functioning to achieve client requirements with regards to timeliness and accuracy, as well as meeting State and Federal regulations, and ensures all compliance elements and performance guarantees are met.
• Oversees the building of Claims Operations team; works to develop employees’ skills, evaluate performance, provide feedback and oversee resolution of employee relations issues.
• Operates within budgetary guidelines with specific attention to the claim unit cost to ensure cost effective, efficient operations and attainment of financial goals.
• Ensures team is managed responsibly as to support budgetary objectives as well as goals or performance guarantees for the client.
• Manages oversight of the Claims operational teams responsible for the timely and accurate processing of claims.
• Manages workforce and budget planning, including resource forecast modeling for peak and non-peak periods. Recruits, attracts, develops, motivates and manages a high caliber of employees, including supervisors; trains employees on products, policies and procedural changes and effectively orients new employees.
• Manages relationships with internal business partners to ensure that claims projects, planning and prioritization meet the business’ needs.
• Effectively completes and utilizes tools including individual and departmental scorecards, performance appraisals and Individual Performance Development (IPD).
• Directs the planning, design, and development of policies and procedures that assure accurate, timely Claims processing.
• Collaborates and partners with Claims supervisors, Finance, Payment Integrity, Provider Network, Utilization Management, Technology and other key stakeholders to create and drive client specific strategies before, during, and after new client and new product implementation as well as steady state claims operations.

Bachelor's degree required.
8+ years of healthcare/managed care experience.
Experience in managing cross-functional, self-directed teams.
8+ years of operational leadership experience in Healthcare IndustryDirector, Claims Operations29Claims, Managed Healthcare, Management/LeadershipBachelors - Business Administration$93,955$159,725