Claims Transformation Director-Managed Care/Medicaid

Location: St. Louis, MO
Date Posted: 09-30-2018
We are pleased to present the following job opportunity with our client!  Take a look and if you meet the requirements please submit your resume and we'll be in touch if you're a good fit!

Job description
Position Purpose: Direct the day-to-day operations of the Claims Department to ensure accurate and timely processing of members medical claims within established state and company compliance guidelines

Position Responsibilities:
  • Oversee implementation of operational efficiencies and development of “best practice” policies and procedures
  • Monitor and analyze costs, prepare annual budget and operate department with the budget
  • Establish consolidated and consistent processes and relationships with internal and external partners to support the business in achieving its strategic and tactical objectives
  • Achieve and maintain all processing and expense standards relating to the Claim Operations
  • Collaborate with various cross-functional leaders to identify and execute process improvements and effective initiatives
  • Oversee all compliance standards for claims, ensuring operations are actively managing and reducing operational risk
  • Oversee change management, and communication and dissemination of critical information to stakeholders, partners, leaders and peers both upstream and downstream
  • Assess progress and report statuses to upper management and key stakeholders including timelines and milestones
  • Analyze customer impact and respond to complex escalated customer service issues to ensure the customer expectations are consistently exceeded

  • Bachelor’s degree or equivalent experience.
  • 8+ years of claims operations, project management, process improvement or shared services experience, preferably in a managed care and/or Medicaid setting.
  • Previous experience with organizational and strategic business process design and development experience preferred.
Preferred Qualifications:
  • Healthcare Consulting experience strongly preferred
  • Business transformation experience working within a large matrix organization
  • Superior knowledge of health care claims adjudication systems including implementation and configuration experience
  • Strong leadership experience and change management experience.
  • Experience managing Enterprise-wide projects (multiple business lines and technologies)
  • Ability to develop and revise project plans, budgets, works with users to understand complex problems.
  • Identify and resolve complex business and technical issues, ensuring a “Best In Class” user experience after implementation.
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!

This position does NOT provide sponsorship so please do NOT apply if you require sponsorship.  Thank You

KP Recruiting Group 
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KP Recruiting Group is a well established and very respected recruiting firm.  We have built a strong reputation as a premier resource for providing highly qualified candidates for our clients.  We are very experienced in many industries and have a wide range of clients.  We will serve as your advocate during your career search!  Let us do the work for you!  There is never a fee for our services!

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