Staff VP, Claims

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

The Staff Vice President of Claims is responsible for all management activities in claims, adjustments and EOB including, but not limited to, maintaining workflow processes, managing performance to established metrics and operational alignment. This includes leadership and accountability of all claims activities for all lines of business including Commercial Group, Individual,

Medicare and Federal Employee Program (FEP). This leader informs and educates teams on updated policies and requirements while ensuring high level of knowledge and service and works closely with the key operations leaders to

streamline, harmonize and continuously improve processes, while building capabilities within the organization. Over the next several years this individual will be a key leader responsible for platform migration.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 10 years in insurance claims management

2. Required Education

· High school diploma in general studies

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· 15 years in insurance claims management

2. Preferred Education

· Bachelor’s degree in a business, healthcare, or related field

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Ensure end-to-end process of claims including claims platform, management of pending claims, EOB & EOPs harmonization and improvement, reviewing, documenting and where possible aligning best practices
• Analyze, define and document key business processes and ensure all necessary staff is educated on workflows
• Focus on accuracy and delivery cadence of reporting data and reports, address and/or escalate any issues with claim performance
• Drive continuous improvement and ensure scalability of processes to support efficient business growth
• Structure and deliver creative solutions while remaining practical, collaborating closely with functional leaders
• Ensure timely and accurate processing of claims and adjustments, managing performance to established metrics
• Act as point of contact for process related topics to line of businesses and COO
• Build and execute change management and communication plans
• Build a culture of process adherence through tracking and monitoring activities and acting on the results
• Produce timely configuration requests to ensure accuracy in administration providers
• Oversee manual processing of claims and vendor relations

STRATEGIC

• Develop and align strategic plans to the corporate strategic pillars for growth, net income, and customer experience
• Translate emerging client needs into actionable business terms and associated process enhancements
• Provide leadership and mentorship to team members on strategy, external research, best-practice analysis, business analysis, and implementation of client-centric business solutions
• Coordinate and assist in development of enhancements to existing systems or creations of new systems to improve efficiencies to enrollment, including capacity modeling, workforce management, service, cost, and quality impact

OVERALL

• Oversee day-to-day departmental administration by coaching and motivating managerial staff and departmental personnel to make maximum use of experience and skills
• Monitor quality performance measures, develop and maintain effective workflows, and seek to maximize system efficiencies
• Manage use of corporate funds including budgeting, financial management, and reporting; Identify opportunities to achieve administrative efficiencies while maintaining service
• Maintain effective working relationships to ensure teamwork in achieving corporate goals
• Coordinate activities between multiple divisions to achieve desired results
• Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals and ensure future success
• Responsible for monitoring and meeting group performance guarantees
• Support BCBSAZ’s Core Value of maintaining a heritage of service, by volunteering with, serving on, and/or supporting multiple Boards of Directors within the community or other community events
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Deep understanding of operational, technical, and internal business processes

· Proven ability to manage individuals and diverse teams within a claims center environment

· Proficiency in business process design and bridging these to operational and technical solutions

· Resource and project management skills

· Ability to create win/win situations

· Interpersonal and oral communication skills, including presentation skills

· Strong written and verbal communications

· Intermediate knowledge of electronic data processing systems, technology, and applications

· Intermediate PC proficiency

· Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones

· Intermediate skill in word processing, spreadsheet and database software

· Intermediate skill using departmental BCBSAZ and BCBSA software

2. Required Professional Competencies

· Experience in software solutions, providers & database systems

· Experience with enterprise-wide and/or cross-functional change initiatives with a high degree of complexity

· Ability to quickly assimilate to new knowledge and continuous improvement mindset, strong organizing and

structuring skills with attention to detail

· Strong leadership and internal stakeholder management skills and the proven ability to drive organizational change

· Enjoys training others and ensuring that people understand and are supported

· Focus on operational excellence and efficiency

· Demonstrated ability to engage with clients or external partners in a vendor/client relationship capacity

· Demonstrated ability to build implementation plans and manage cross functional teams to achieve them

· Strong familiarity with internal operational architecture and business processes

· Solid creative judgment and ability to think strategically

· Advanced analytical and diagnostic skills dealing with issues that are often novel and not readily defined, lack known

precedent or appear contradictory

· Expertise in the use of formal and informal communications and the ability to give presentations that effectively

communicate goals, ideas and concepts in alignment with audience needs, including frontline employees, managers,

peer leaders and executive leadership

· Management skills in an operationally changing environment, with drive for results and success based on planned

objectives

· Expert knowledge of the principles and practices of call center metrics

· Expert customer service skills

· Interpersonal skills that allow for harmonious relationships with providers, members and coworkers

· Recognize strategic opportunities and use data to make timely and sound decisions · Flexibility and willingness to adjust to shifting demands/priorities · Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs · Ability to optimize resources to ensure cost effective operations, including proactively identifying staff moves from one role to another as staffing needs change

3. Required Leadership Experience and Competencies

· Ability to lead others in the same or higher levels to a valuable solution that may be novel or have no known set

precedence in the client experience or operational areas

· Decision analysis skills (ability to separate a complex whole into component parts)

· Ability to empower associates at all levels and encourage innovation and risk taking

· Ability to effectively cope with multiple priorities, high customer expectations and bridge the demands between

internal and external customers

· Resource management skills with the ability to develop an enthusiastic and positive work climate

· High standard of performance while pursuing aggressive goals

· Principled leadership and sound business ethics

· Strong people person

PREFERRED COMPETENCIES

1. Preferred Job Skills

· Advanced PC proficiency

· Advanced proficiency in spreadsheet, database, presentation, and word processing software

2. Preferred Professional Competencies

· N/A

3. Preferred Leadership Experience and Competencies

· N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.