Executive Director of Claims
Company: Providence Health & Services
Location: Renton
Posted on: November 7, 2024
Job Description:
Executive Director of ClaimsLocation: Renton, WashingtonReqID:
310236Job Category: ClaimsSchedule: Full timeWork Location:
Providence Valley Office Park-RentonShift: DayDescriptionTHE
ROLEThe Executive Director directs, manages, and oversees the
activities of the delegated claim operations including claim
adjudication, processing encounter data, and maintenance of current
eligibility and benefits information. Expectations include
compliance with applicable Federal, State, health plan, and
contractual regulations and guidelines. The Executive Director
Claims Operations interfaces with internal and external resources
and departments to maintain current industry knowledge and
participate effectively on process development efforts focused on
achieving continuous improvement in operational efficiency,
processing accuracy, and customer service performance.ESSENTIAL
FUNCTIONS
- Lead best-in-class liability claim organization responsible for
managing all liability lines, including hospital professional
liability, general liability, cyber liability, D&O, employers
liability, and managed care, as well as leveraging claim insight to
provide feedback to partners across ministries and shared services
to manage risk and identify emerging risks.
- This position leads leaders and is responsible for ensuring all
leaders have appropriate development and training support to lead
teams to deliver exceptional results.
- Ensure optimal claim model and strategies, including consistent
enhancements, leveraging digital and data-driven strategies to
drive efficient workflows and processes and support development of
impactful claim insights.
- Ensure compliance with all relevant regulations, including
state and federal reporting, and develop operational strategies to
drive efficient, low-touch, and accurate reporting
capabilities.
- Drive effective claim strategies, including effective
management of pre-suit and litigated large loss and severity
claims, including early and thorough assessment of issues, proper
analysis and use of data, accountability, budget discipline,
technical and professional development, trial acumen/appetite, and
innovative and strategic use of resources.
- Ensure sound financial management practices, including
effective reserving and settlement strategies to ensure reasonable
outcomes and forecast exposure.
- Identify training needs and lead production of tailored
training and development resources for claim professionals and
leaders.
- Partner with shared services leaders and risk managers across
the ministries to understand needs and support effective knowledge
sharing and collaboration to manage risk.
- Develop, monitor, and report key measurements and trends to
leadership.QUALIFICATIONS
- Bachelor's Degree; or equivalent educ/experience.
- Master's Degree, or J.D. (preferred).
- 10 or more years of experience with responsibilities in
high-volume transaction processing, information interpretation,
presentation, and application to internal and inter-departmental
efficiency.
- 8 years of proven leadership ability to interact and
communicate at all levels of an organization. Organizational,
interpersonal, and communications skills and the ability to manage
shifting priorities are critical for success in this position.
- Expertise includes delegated medical group functions,
management, and analysis.
- Must possess excellent oral and written communication, and
computer skills encompassing various software applications
(database applications such as Access, data warehouse environment,
Excel, Word, PowerPoint, etc.).
- Make effective presentations to communicate performance
expectations, activities, and results.
- Working knowledge of change and transition management and the
creation of programs and processes to maximize efficiency and
support company goals through transitions.
- Maintain effective and professional relationships with hospital
and health plan partners.
- Work in a collaborative and collegial manner to achieve
continued enhancement and improvement of operating results.About
ProvidenceAt Providence, our strength lies in Our Promise of "Know
me, care for me, ease my way." Working at our family of
organizations means that regardless of your role, we'll walk
alongside you in your career, supporting you so you can support
others. We provide best-in-class benefits and we foster an
inclusive workplace where diversity is valued, and everyone is
essential, heard, and respected. Together, our 120,000 caregivers
(all employees) serve in over 50 hospitals, over 1,000 clinics, and
a full range of health and social services across Alaska,
California, Montana, New Mexico, Oregon, Texas, and Washington. As
a comprehensive health care organization, we are serving more
people, advancing best practices, and continuing our more than
100-year tradition of serving the poor and vulnerable.Providence
offers a comprehensive benefits package including a retirement
401(k) Savings Plan with employer matching, health care benefits
(medical, dental, vision), life insurance, disability insurance,
time off benefits (paid parental leave, vacations, holidays, health
issues), voluntary benefits, well-being resources, and much more.
Learn more at providence.jobs/benefits.Pay Range: $64.34 -
$111.34The amounts listed are the base pay range; additional
compensation may be available for this role, such as shift
differentials, standby/on-call, overtime, premiums, extra shift
incentives, or bonus opportunities.
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Keywords: Providence Health & Services, Seattle , Executive Director of Claims, Executive , Renton, Washington
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