Senior Operations / Vendor Manager-13006959
Primary responsibility is to oversee/ monitor/ manage production and quality, training, auditing, staffing levels and other activities to ensure timely and accurate claim processing. Position will also ensure vendor partners are compliant with State Insurance Regulations. The position requires results to be monitored and reported as appropriate, ensures that State and regulatory requirements are met for all product lines. The Manager will assist with budget development. In addition, the position requires the ability to communicate and work on a cross functional basis within the claim department and with various departments to achieve the goals of the department and the overall organization (i.e. work distribution, gap analysis, workflows, process improvement, system enhancements, etc). The Manager will be responsible for coaching, mentoring, developing and performance managing the staff. Primary duties include the following:
- Monitors and ensures production, quality, and inventory metrics are met. Develops remediation plans and works with necessary areas as appropriate to ensure service levels and goals are met/exceeded.
- Works with Vendors to ensure intake call center scripts are updated to support claims processing changes.
- Participates with and prepares for outside audits. Assists in preparation of any reporting or remediation plans as appropriate.
- Provides effective personnel management including performance reviews, staff development, coaching/mentoring, and discipline. Assists in determining and managing to appropriate staffing levels based on the types and volume of work.
- Assists in development and implementation of goals, incentives, etc to drive performance and minimize turnover.
- Assists in development, implementation, and monitoring of strategic and operational initiatives. Participates in and leads special projects as assigned.
- Ensure effective interdepartmental communication, workflow, and procedures are in place to meet the goals of the department and the health plan. Provide recommendations and implementation of improvements in efficiency generated by technology or workflow changes.
- Assists in developing and maintaining the appropriate policy and procedures related to department operations.
- Assists in development of operational budget for the department and is responsible for ensuring the department manages to the budget.
- Special Skills: Strong attention to detail with excellent oral and written communication skills. Good understanding of system processes. Ability to supervise and motivate staff.
- Ensures activities performed at Vendor partners are in compliance with state insurance requirements.
- Participates in projects that impact processes at Vendor partners and ensures timely completion of deliverables as defined by the project team.
- Completes call and claim monitoring on Vendor partners and publishes results on a quarterly basis.
- Provides support to Corporate Compliance and Licensing groups and will meet timelines set by those groups for projects identified
- A minimum of 6 years relevant insurance operations work experience
- A minimum of 2 years experience in risk and/or fraud investigation or comparable technical support operations management
- A minimum 2 years experience in basic data analysis and interpretation
- 2+ years experience using Microsoft Excel in a business setting
- Six Sigma, Black/Green Belt and/or Lean experience a major plus
- Must pass the Rhode Island P &C Insurance licensing exam within 3 weeks of start date ( three company paid attempts)
Primary Location: US-Arizona-Phoenix
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