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Director, Claims
Supv LocationINDEPENDENCE
Posting Closes
SupervisorDavid Koenig
Job Code172316
DepartmentCLAIMS ADMINISTRATION
  
Job Responsibilities
GEHA is an Equal Opportunity Employer with five locations in the Kansas City metropolitan area. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470. The claims processing office and call center is located in Independence near Little Blue Parkway and I-70. All offices are easily accessible by freeway from anywhere in the Kansas City metro area.

Open Positions: 1
Location: Independence, MO (Landmark Building)
Department: Health Plan Business Operations

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

Summary

The Director, Claims is responsible for leading and managing the day-to-day operations of the claims department functions to produce exemplary results. The Director, Claims provides appropriate technical and managerial support ensuring key performance indicators mandated by the Office of Personnel Management (OPM) and internal requirements and goals are met. This role interacts and coordinates with various department and the medical director to ensure appropriate case disposition and clinical decisions are being conducted. The incumbent provides project leadership for ongoing process improvements, system enhancements and software implementations.

Duties

• Responsible for providing operational and administrative oversight to the Claims Division. Responsible for ensuring business practices and processes are in line with industry standard practices. The Director, Claims, is knowledgeable of Federal, State and ACA requirements related to claims processing and ensures that processes are in place to comply with these requirements.

• Responsible for ensuring a competent and motivated staff through selecting, training, and directing claims’ staff. Determine actions on promotions, termination, or reassignments of subordinates. Conduct meetings with subordinates to communicate organizational and departmental changes as necessary. Review ongoing performance of department staff, and participate in development programs that provide for continuity of managerial and specialized skills, and ensure appropriate succession planning for the Claim’s function.

• Responsible for leading, managing and motivating staff to obtain performance levels at or above claims production standards relating to claims in-process inventory, turn-around time, and processing accuracy. Ensure that standards are in compliance with OPM requirements as well as internal protocols and goals.

• Responsible for collaborating with appropriate department’s management team, maintain adequate security over claims documents and other confidential data as prescribed by company policies and required by State and Federal law, including HIPAA privacy and security provisions.

• Responsible for facilitating a culture capable of supporting significant change initiatives based on the corporate focus of claims process operational excellence and creating an exceptional member experience.

• Responsible for the execution of best practices in claims processing, cost containment, claims technology, quality assurance and member satisfaction initiatives.

• Responsible for establishing and managing to a set of consistent key performance metrics in order to measure the function’s success and opportunities for process or procedural improvement. This would include the formal monthly reporting and presentation of key performance metrics and resource requirements progress against plan.

• Responsible for facilitating a culture that embraces and utilizes process improvement techniques such as DMAIC, Six Sigma and LEAN Sigma. Responsible for leading a team of individuals who support process improvements throughout the company.

Education Requirements
Requires a B.A. /B.S. in Business or related field of study or equivalent work experience. MBA and industry certifications preferred.

Experience Requirements
Must have 6-8 years of progressively responsible claims management experience with at least 3 years of claims leadership experience and staff responsibility. Requires 4-6 years of operations management experience with respect to medical and/or dental claims processing in a medical or dental claims processing environment. Demonstrated experience in leading and inspiring a large claims organization through transformational change. Demonstrated ability in partnering and collaborating across the enterprise on significant business initiatives and process changes. Demonstrated experience in developing, communicating and implementing key performance metrics to enhance continuous functional improvement. Demonstrated experience in communicating to all levels of the organization and inspiring employee engagement. Demonstrated experience in effectively bridging gaps between short and long tenured staff through functional transformational change initiatives. Demonstrated experience working with process improvement methodologies such as DMAIC, Six Sigma and LEAN Sigma.

Core Competencies
• Accountability: Owning and taking responsibility for one’s actions.

• Business Acumen: Understanding industry, market, financial and company specific operations.

• Process Focused: Continually reviewing processes for efficiency. Reducing and eliminating waste.

• Collaboration and Communication: Working together; listen to other’s ideas; communicate accurately and concisely.

• Decision Making / Produce Results: Consider all facts and impacts when making decisions.

• Focus on the Customer: Consistently doing what is in the best interest of our customer. Leaving a positive impression on the customer by elevating their experience; making it simpler and educating to helping them understand.