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Staff Vice President Commercial Government Claims - Medicare, Medicaid

Company: Top Echelon
Location: Virginia Beach
Posted on: November 22, 2021

Job Description:

Featured Apply Relocation assistance available

  • Responsible for developing the claims payment and adjustment strategy in Government Business Division Claim Operations. Primary duties may include but are not limited to:
  • Leads multiple claims processing units, executes strategies to deliver industry leading service results.
  • Improves processes and partners across lines of business to develop consistency and share best practices.
  • Drives results to improve provider satisfaction.
  • Builds strong partnerships with Plan Presidents, collaborates with IT, Enterprise Benefit Administration, Provider Services, Quality and Internal Audit.
  • Leads systems consolidation efforts, compliance requirements, and monitors state/federal regulations.
  • Manages special projects and budget oversight.
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports. Requirements Requires a BA/BS in business administration or a related field; 10 + years of management experience in claims that includes adjustments in the managed care and/or insurance industry; or any combination of education and experience, which would provide an equivalent background. MBA preferred. Hiring Managers preferred skillset & experience IDEAL EXPERIENCE
    • Government - Medicaid and/or Medicare
    • Transaction Operations, Claims preferred
    • Leadership Depth and Breadth
    • Oversight of vender relationships and operations transition experience preferred
    • Focused on metric driven results, identifies and analyzes problems using facts and data to leverage resources available and solve problems creatively.
    • Formulates objectives and priorities. Implements plans consistent with the long-term interest of the business unit and organization. Capitalizes on opportunities and manages risks.
    • Develops new insights into situations; questions conventional approaches; encourages new ideas and innovations.
    • Builds a shared vision with others; acts as a catalyst for organization change. Influences others to translate vision into action.
    • Expresses ideas clearly and uses language to build common understanding. Works across the organization to build collaborative relationships.
    • Resourceful; overcomes obstacles. Aligns resources to accomplish key objectives and assigns clear accountability for important objectives.
    • Inspires and motivates others to take action.
    • Fosters an inclusive workplace where diversity and individual differences are valued and leveraged to achieve the vision and mission of the organization

Keywords: Top Echelon, Virginia Beach , Staff Vice President Commercial Government Claims - Medicare, Medicaid, Executive , Virginia Beach, Virginia

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