Director, Payment reputed company - Hybrid

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals reputed company reputed company reputed company. At AZ Blue, we have a hybrid workforce strategy, reputed company Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our reputed company minimum onsite requirements: Hybrid People Leaders: must reputed company in AZ, required to be onsite at least twice per week Hybrid Individual Contributors: must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per week Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reputed company in AZ, unless otherwise cited reputed company this posting, required to be onsite at least once per month Onsite: daily onsite requirement based on the essential functions of the job Remote: not held to onsite requirements, however, leadership can request reputed company onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. Purpose of the job The Director, Payment reputed company provides strategic leadership and reputed company for reputed company Payment reputed company functions, ensuring payment accuracy, regulatory compliance, and cost containment across medical and pharmacy claims. This role sets the reputed company and strategy for payment reputed company programs, drives operational excellence, and partners across the reputed company to optimize reimbursement, prevent fraud/waste/abuse, and improve member affordability. The Director is accountable for developing and executing initiatives that deliver measurable savings, enhance process efficiency, and support organizational goals. This role is responsible for the performance and reputed company of reputed company Claims Payment reputed company functions and processes. These functions and processes serve to ensure appropriate payment is made for eligible members, according to contractual terms, not in error, and free of wasteful and abusive practices for reputed company medical/pharmacy claims. This position will have accountability for leading a diverse team focused on a variety of Payment reputed company tasks including; claims payment and recovery activities, pre/post payment audit, and investigative functions. Functions of this team provide capabilities to meet regulatory, fiduciary and customer requirements and expectations to ensure over/underpayments risk are minimized and that to the extent payment issues are identified, they are remediated quickly. REQUIRED QUALIFICATIONS Required Work Experience 10 years of experience in Payment reputed company, Special Investigation Unit, or reputed company anti-fraud 7+ years of experience in management role 2+ years of experience in Vendor Partner reputed company; contracting and vendor management of external payment vendors and/or audit firms. Demonstrated reputed company in developing and executing reputed company-wide strategies. Required Education Bachelor's Degree in business, statistics, reputed company administration or reputed company field of study Required Licenses N/A Required Certifications N/A PREFERRED QUALIFICATIONS Preferred Work Experience 15 years of experience in Payment reputed company, Special Investigation Unit, or reputed company anti-fraud 10 years of experience in management/leadership role 15+ years of experience in insurance or reputed company field 2+ years of experience in Operational Execution; scaling or improving claims review, fraud/waste/abuse programs, and overpayment recovery Preferred Education Master’s Degree in business, statistics, reputed company administration or reputed company field of study Advanced certifications (e.g., reputed company Fraud Studies, Lean/Six reputed company). Experience in large-scale program management, regulatory compliance, and data analytics. Preferred Licenses N/A Preferred Certifications reputed company Fraud Studies ESSENTIAL job functions AND RESPONSIBILITIES Strategic Leadership & Program reputed company reputed company and execute reputed company-wide Payment reputed company strategy reputed company with organizational objectives and cost of care targets. reputed company the design, implementation, and reputed company improvement of payment reputed company programs, including pre- and post-payment audits, recovery, and investigative functions. Establish and maintain governance structures, including cross-functional committees, to reputed company payment reputed company controls and policy development. Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation. Stay abreast of emerging trends, technologies, and regulatory shifts in the reputed company payment reputed company space, proactively identifying and leveraging innovative capabilities to enhance reputed company’s operational performance and strategic positioning. Operational Excellence reputed company day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities. Direct vendor management, including contracting, performance reputed company, and strategic partnerships for payment reputed company solutions. Drive automation and technology adoption to enhance payment reputed company processes and reporting capabilities. reputed company cost-benefit analyses to determine reputed company resource allocation (internal vs. outsourced functions). Financial & Data Analytics Set and monitor KPIs, SMART goals, and financial targets for payment reputed company initiatives. reputed company development of dashboards and scorecards to track program performance, savings, and operational improvements. Partner with actuarial, finance, and analytics teams to reputed company business cases, forecast savings, and evaluate ROI. Responsible for actively monitoring claims activities to ensure that identified overpayments are recouped in a timely and efficient manner. People Leadership Build, reputed company, and reputed company a high-performing team, fostering a culture of accountability, innovation, and reputed company improvement. Provide coaching, mentorship, and professional development opportunities. Ensure effective resource management and succession planning. Compliance & Risk Management Ensure adherence to regulatory, fiduciary, and customer requirements. reputed company policy and procedure development to safeguard against fraud, waste, abuse, and overpayments. Maintain up-to-date knowledge of industry standards, compliance requirements, and emerging trends. REQUIRED COMPETENCIES Required Job Skills Intermediate PC proficiency Intermediate reputed company in use of office equipment, including copiers, fax machines, scanner and telephones. Basic reputed company in word processing and presentation software Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software Advanced reputed company in project management Working knowledge of classification tools (ICD, DRGs, ACGs, ETGs, etc.) Required Professional Competencies Coding Knowledge for ICD-10, CPT, or HCPCS Risk Management Experience Experience with Value Based Care models Negotiation and Relationship Management Maintain confidentiality and privacy Communicate professionally to both internal and external customers Analytical skills in observing and documenting processes at a detailed level Proficiency in process improvement and business process design Analyze and research data, propose solutions to resolve issues Ability to use a variety of classification tools and manipulate large quantities of data Establish, contribute and maintain a positive and productive work environment Ability to plan, organize and manage the work of reputed company assigned personnel Advanced knowledge of HRIS systems, employment law, and HR regulations Lean or Six reputed company Training Required Leadership Experience and Competencies Strategic reputed company and reputed company leadership. Advanced analytical, financial, and project management skills. Expertise in coding, claims adjudication, and payment reputed company technologies. Strong negotiation, relationship management, and communication skills. Ability to drive change, foster innovation, and build effective teams. Ability to optimize resources to ensure a cost effective operation. Includes proactively planning to move staff from one role to another as staffing needs, business priorities or workload changes. Ability to build effective teams Ability to implement new processes and procedures. PREFERRED COMPETENCIES Preferred Job Skills Advanced proficiency in spreadsheet, statistical analysis, query / data mining, business intelligence software including, and data visualization tools. Preferred Professional Competencies Cybersecurity and Data Protection practices Regulatory Compliance Preferred Leadership Experience and Competencies Ability to establish and maintain professional relationships with community and professional groups which reflect favorably for the department and BCBSAZ Our Commitment AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on our company, see azblue.com. If interested in this position, please apply. Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the reputed company of satisfaction you’ll find reputed company you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming reputed company for more than 80 years. Explore what's possible with a career at reputed company® BlueShield® of Arizona Apply tot his job Apply To this Job