Director Claims Cost Management - Shared Services

Profile

Description

The Director, Claims Cost Management uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our financial recovery. The Director, Claims Cost Management requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, Claims Cost Management contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims payment. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

Required Qualifications


6 Years of payment integrity experience / claims processing
5 or more years of leading a large organization
Able to determine the needed approach, resources, and goals to meet business objectives
Demonstrated experience with cross departmental collaboration
Experienced facilitating, consulting, and delivering complex concepts
Communicating complex problems in an easy to understand format
Able to determine the root cause of issues / problems
Comprehensive knowledge of Microsoft Office Programs Word, PowerPoint, and Excel
Ability to handle multiple priorities
Capacity to maintain confidentiality
Excellent communication skills both written and verbal
Proficiency in analyzing and interpreting financial trends
Strong collaboration skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences


Preferred Qualifications


Experience leading projects and processes
Experience with the CAS and/or MTV systems
Knowledge of Microsoft Office Programs Access and Project


Scheduled Weekly Hours

40

Company info

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