Are you called to serve as a transformational change agent? As the Vice President of Claims Operations you’ll get the chance to live and breathe our mission of inspiring healthy living within the communities that we serve with a focus on those who need care the most. Reporting to the Associate Chief Operations Officer (COO) of Virginia Premier, our Vice President of Claims Operations will be a key member of the executive leadership team and will be tasked with aligning the Claims Operations department with our strategic initiatives of innovation, strategic partnerships and industry-leading health care.
A day in the life of a VP of Claims Operations:
Establishing close partnerships, mutual accountability and strong communication between the Claims Operations area and all other areas of the business.
Providing strong leadership support to both the people and processes of that support provider claims payment.
Contributes to business planning and reviews operating/financial results with appropriate personnel to identify areas of opportunity and address significant variances.
Ensuring effectiveness of the claims payment processes, while closely partnering and working in tandem with the Vice President of Claims Information Systems.
Responsible for accurate claims adjudication and payment processes. Manages production areas within Claims, delivering accurate, timely and efficient service to providers.
Integrates best practices for all claims functions and operations, including value based payment programs. This will involve improving claims payment accuracy, timeliness and decreasing processing costs per claim.
Lead and participate in health plan management activities related to claims payment accuracy and timeliness, benefit analysis, system configuration, payment appeals, regulatory/contractual compliance.
Utilizes data, information, process analyses and industry knowledge to set priorities, make operational recommendations and decisions, and measure results.
Leads end-to-end claim process improvements to achieve corporate objectives related to claim payment accuracy and timeliness.
Demonstrates successful leadership in selecting, developing, motivating and directing a highly effective team, which includes mentoring, training and providing guidance to ensure continual growth of management staff.
Who’s right for the job?
A change agent. An accountable leader who fully understands how to support both people and process. Someone who isn’t content with the status quo and enjoys continuous improvement and process optimization in the Claims space. A true partner who is driven to go above and beyond to encourage communication and collaboration across all areas of an organization.
MINIMUM EDUCATION REQUIREMENTS
Bachelor’s Degree in business administration, healthcare or other related field required.
Master’s Degree in a relevant discipline such as business or health care administration or 10 years equivalent work background and experience.
10 years (minimum) of experience managing business operations, with at least five (5) in a senior leadership capacity. Evidence of progressive responsibility for multiple functional areas.
7 years (minimum) of claims experience in managed care setting, in progressive leadership and supervisory/management roles.
3 years (minimum) of experience on multiple claim system platforms desired, inclusive of a claims system conversion.
Experience managing claims administration for governmental programs, including Medicare, Medicaid, and Exchange.
Demonstrated experience in the successful leadership and management of organizational growth and change initiatives is critical to this position.
Experience or knowledge of best practices in Claims payment including value based payment models.
SPECIAL KNOWLEDGE & SKILLS
Knowledge of QNXT claims platform is strongly preferred.
Proven experience and understanding of multiple lines of business in the Claims space of a managed care (health insurance) organization.
Strong qualitative, quantitative and process analytical skills, demonstrated by ability to identify and use information and data to set goals and priorities, make decisions, and measure performance.
Ability to take initiative, think independently, and contribute constructively to strategic planning, priority-setting and decision-making.
Ability to instill in others an appropriate sense of urgency that results in sustained organizational success.
Demonstrated high degree of integrity, trustworthiness, respect for others, and proven ability to effectively lead and develop a diverse team through organizational change/growth.
Physical health sufficient to meet the ergonomic standards and demands of the position
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!
Internal Number: 2018-5268
About Virginia Premier
Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Bristol, Roanoke, Tidewater, Winchester and Arlington allowing us to serve over 200,000 members across eighty counties throughout Virginia.