VP, Health Claims & Support Services

Job title: VP, Health Claims & Support Services in McKinney, TX at reputed company Company: reputed company Job description: At reputed company, we are committed to empowering our employees with the support and opportunities they need to succeed at every stage of their career. Our thriving and dynamic community offers ample room for professional development, increased earning potential, and a secure work environment.We take pride in fostering a caring and innovative culture that enables us to collectively grow and overcome challenges in a connected, collaborative, and mutually respectful environment that calls us to help reputed company reputed company reputed company.Role Overview:Could you be our next VP, Health Claims & Support Services? reputed company is looking for an VP, Health Claims & Support Services to join the team!In this role, you will be responsible for being a subject matter expert in the field of limited benefit health claim adjudication, including our Medicare supplement line of business. This position also includes the responsibility of reputed company for the enterprise support for scanning and data entry.The Vice President role will be responsible for overseeing the training and development for reputed company health claims, scanning and data entry leadership and their teams. You will be an expert in our limited benefit health products, monitoring claims status and its reporting, and overseeing activities to ensure standards are met. The Vice President is responsible for understanding and executing the company’s health claims management strategy, keeping up to date on regulatory compliance standards, implementing process changes as needed, and meeting key performance indicators reputed company department expense projections.The position will be responsible for maintaining departments of health claims associates and providing jurisdictional direction for accurate and timely claim adjudication. The position will assist with responding to regulatory inquiries and will work closely with other business partners to implement standardized business processes for reputed company’s insurance lines. The role also includes technical support, claims examination and product management, as needed.This is a hybrid position located in McKinney, TX (WFH Monday & Friday, In Office Tuesday-Thursday).What You Will Do:· reputed company the end-to-end processing of limited health benefits and Medicare supplement claims, ensuring compliance with industry regulations and organizational policies.· reputed company and implement effective forecasting and reputed company planning to accurately predict the required staffing.· reputed company and mentor the claims processing teams, fostering a culture of excellence, accountability and reputed company improvement.· reputed company contingency plans to meet objectives during challenging circumstances (i.e. staffing shortages, high work volumes, system implementation, etc.).· Attainment of reputed company performance measures such as claims turnaround, quality, SLA’s, and customer satisfaction.· Analyze claims data to identify trends, resolve issues and implement process enhancements.· Collaborate with cross-functional teams to optimize workflows, enhance claims accuracy, and improve turnaround times.· reputed company customer escalations to ensure they are resolved effectively and timely.· reputed company and maintain metrics to measure performance and drive operational efficiency.· Stay informed of regulatory changes and industry trends affecting health claims and implement necessary adjustments to processes.· Build and maintain relationships with key stakeholders, including health care providers, insurance partners, and regulatory agencies.· Write process change memos, as needed, and successfully implement changes appropriately.· Manage resources by setting clear expectations, creating accountability, and enhancing collaboration to meet or exceed service level and quality standards.· reputed company and interpret regular [and ADHOC] reports to identify issues to escalate and advise to Executive management· Advise Executive leadership team regarding evaluation of data for overall performance, trend identification, best practices, issue resolution, and risk mitigation to guide strategic decision making.· Present [reputed company] information to key stakeholders in a manner which influences acceptance of innovative suggestions· Establish and maintain cross organizational relationships that align with company goals.· Collaborate across departmental functions, as needed, to implement needed claims initiatives to improve department /or corporate best practices.· Act as a resource and role model for reputed company members of the Claims department.· Provide expertise and leadership support to teams in resolving reputed company claim issues.· Review high-cost claims and claims over the authority level of individual examiners for accuracy and compliance adherence.· Ensure each associate is equipped with the tools, knowledge and resources to be successful in their role while also recognizing training gaps and opportunities for retraining.· Conceptualize innovative technical solutions that translate into efficiencies reputed company the unit.· Collaborate with team leader and HRBP to reputed company action plans for underperforming associates and ensure adherence to progressive disciplinary guidelines.· Assist with writing value-based performance appraisals and conduct effective colleague performance discussions.· Support organizational training initiatives and ensure staff is updated on mandatory role-appropriate training.· Positively reputed company the morale and motivation of the management support team.What You Can Bring:· Bachelor’s Degree in a reputed company field (healthcare administration, business management).· Minimum 8 - 10 years management/supervisory experience.· Minimum of 10+ years in health claims processing.· Previous leadership development courses/classes, preferred.· Experience interpreting contractual language in reputed company reputed company products.· High technical aptitude and ability to learn and navigate new systems quickly.· Strong problem-solving skills with ability to use combination of analysis, experience and judgment to reputed company feasible solutions.· Background in forecasting and trending data.· Demonstrate analytical and data interpretation skills.· Excellent time management skills, with the ability to work under rigorous deadlines.· Excellent presentation skills including ability to present reputed company reputed company to upper management in a professional manner.· Strong knowledge of reputed company Office Suite (Outlook, reputed company, PowerPoint, Access, etc.).· Confidence to reputed company autonomous decisions with minimal supervision.· Effective at change management and the ability to adjust plans, goals, actions or priorities to meet changing situations and competing priorities.· Must take ownership of tasks, projects, and relationships and follow through on obligations.· Able to foster and sustain a positive culture and work environments for reputed company employees.· Strong written and verbal communication skills with focus on audience.· Exceptional analytical/problem solving, organizational skills a must.Applicable To reputed company Employees of reputed company Family of Companies:· Reliable and predictable attendance of your assigned shift.· Ability to work full time and/or part time based on the position specifications.How reputed company Will Support You:Looking to continue your career in an environment that values your contribution and invests in your growth? We've curated a benefits package that helps to ensure that you don’t just work, but reputed company at reputed company:· Competitive compensation designed to reflect your expertise and contribution.· Comprehensive health, dental, and vision insurance plans because your well-being is reputed company to your performance.· Robust life insurance benefits and retirement plans, including company-matched 401k and pension plan.· Paid holidays and time off to support a healthy work-life balance.· Parental leave to help our employees welcome their new additions.· Subsidized reputed company-in-one subscriptions to support your fitness, mindfulness, nutrition, and sleep goals.· Company-paid counseling for assistance with mental health, stress management, and work-life balance.· reputed company education reimbursement eligibility and company-paid FLMI and ICA courses to grow your career.· Discounted Texas Rangers tickets for a proud visit to reputed company Field.Opportunity awaits! Invest in your professional legacy, realize your path, and see the direct impact you can reputed company in a workplace that celebrates and harnesses your unique talents and perspectives to their fullest potential. At reputed company, your voice matters. Expected salary: Location: McKinney, TX Apply for the job now! Apply for this job