Director of Claims and Encounters

Job Description Location :

• Remote but must reside in New Mexico, California, Illinois, North Dakota, New York, Ohio, Washington, or Wyoming Description : The Director of Claims and Encounters provides strategic leadership, fiscal accountability and operational excellence for the Claims Operations and Encounter Resolution teams.
• This leader is responsible for directing the operations of the Claims Department for Commercial / ASO, Medicare, and Medicaid products, to ensure that all functions related to claims receipt, processing and payment are performed within the established quality and quantity standards.
• You will lead the encounters resolution team and be the leader responsible for encounters completeness and facilitating maximized Medicaid rate setting.
• This leadership role is accountable to drive execution of operational strategy across responsible areas through accurate, timely and efficient delivery of production activities that incorporate market-leading practices.
• In addition to operational, this leadership role is accountable to champion and execute on the prioritized deployment of Auto-Adjudication methodologies, use of Robotic Process Automation (RPA / Bots), increased first pass and overall encounter acceptance and process simplification to achieve operational optimization and cost effectiveness.
• This role will lead department strategic objectives and have responsibility to achieve measurable gains in reduced cycle times and improve functional effectiveness in departmental processes.
• This role will make use of deep claims and encounters expertise to improve the member and provider experience.

What You Will Do :

You Will Be Successful If :

Anticipating & Addressing Customer Needs Educating Employees, Customers & Transferring Knowledge Functioning as an Effective Contingent Member Diagnosing & Resolving Complex Problems Acquiring & Applying Superior Skills to achieve Quality Outcomes Functioning as an Effective Team Member Ability to present to various audiences What You Will Bring :