Dir Claims Operations

HealthEquity

1mo ago

Job
Full-time
Expert Level
People, HR & Administration
Healthcare
United States
Remote

AI generated summary

You need 10+ years in high-volume claims processing, strong leadership and communication skills, process improvement experience, and expertise in resolving complex issues. HR or financial services background preferred.
You will ensure exceptional service, improve efficiency, manage claims processes, set goals, oversee budgets, handle HR activities, and maintain industry knowledge through ongoing training.

Requirements

The ability to effectively plan, develop, and direct all aspects of a claims and transaction processing business as normally obtained through at least 10 years’ experience in a high-volume claims processing environment at a manager level or greater.
A proven track record for service excellence, process improvements, integrity and ethics.
Excellent negotiation, leadership, communication, presentation and interpersonal skills are required to perform the functions as described. Incumbents must have the ability to navigate political arenas with ease as well as persuade and negotiate with others while projecting a professional image.
A demonstrated ability to resolve complex process/systems issues through the identification and analysis of problems from root cause to strategy development and execution is necessary. Incumbents must have the ability to implement and manage comprehensive policies, programs and initiatives as described.
A strong attention to detail and the ability to remain highly organized, professional and focused is essential. Excellent planning, time management, decision-making and organizational skills are required. Incumbents must be able to employ good analytical skills to develop and implement actionable work plans to meet organizational needs.
Experience in the HR service, financial services or similar industries is preferred.

Responsibilities

Remarkable ‘purple’ service to internal and external customers, embracing the feedback provided as a basis for evaluating quality and determining opportunities for investment to maintain and enhance customer loyalty.
Continuous, sustainable efficiency improvement through investments in customer self-service, automation, process engineering, strategic in/outsourcing and other strategies.
Provides direction to Claim Operations management team, establishing major functional roles, courses of action and tactical programs that are aligned with strategic long-term division objectives and directly related to the core values of the business. Provides leadership in the definition and establishment of standards, internal control mechanisms, key performance measures and standard operating procedures across multiple platforms. Represents and communicates this approach to management and staff.
Directs and oversees the initial and ongoing evaluation of customer needs and establishment of processes and procedures related to daily Claims Service Administration. Ensures overall customer satisfaction by supporting and/or promoting continuous improvement of account management, administrative processes, client set-up, ongoing administration, and claims services. This includes providing support to the sales team in client presentations, site visits, proposals and projects.
Sets tactical and long-term goals for each team, aligning objectives with targets established by the division’s executive leadership team. Develops metrics related to key business drivers to measure performance and then monitors, assesses and evaluates performance. Takes action to change the course of direction, including recommending and/or approving changes in plans. Reports progress and performance to leadership as appropriate and provides feedback to team members on results.
Regularly reviews the progress and quality level of service operations. Ensures that questions are addressed, decisions have been acted upon and problems have been resolved. Directs meetings where necessary to address escalated issues and resolve problems.
Handles and oversees administrative matters concerning the service organization, including preparing and submitting assigned claims budgets for approval. This position is also responsible for monitoring and controlling budget performance and taking action to implement cost saving strategies where available.
Determines areas of cost reduction and program improvement where appropriate and modifies strategies, organization of resources and business plans where necessary. This position has full cost center accountability and specific responsibility for margin targets as assigned.
Initiates and approves human resource planning, selection and resource allocation activities that support the Claims teams’ productivity and effectiveness. This includes ongoing responsibility for personnel actions, including hiring and scheduling employees; training and evaluating employees; coaching, counseling and managing performance; and making salary, merit or other pay increase recommendations. Makes recommendations and/or takes corrective action to manage performance as appropriate.
Maintains a level of currency in claims operations as well as the HR services industry by participating with and maintaining memberships with professional work groups; attending trainings, seminars, and other business-related conferences; and interfacing with peers.

FAQs

What is the primary mission of the organization?

The primary mission is to save and improve lives by empowering healthcare consumers.

What is the main responsibility of the Director of Claims Operations?

The Director is responsible for the overall strategic direction and daily operational functions for Claims Operations, including planning, developing, and directing all aspects of the organization’s claim programs.

What experience is required for this position?

At least 10 years of experience in a high-volume claims processing environment at a manager level or greater is required.

What skills are essential for success in this role?

Essential skills include excellent negotiation, leadership, communication, presentation, and interpersonal skills, along with strong attention to detail and organizational abilities.

Will this position involve overseeing a team?

Yes, the Director will provide direction to the Claims Operations management team and establish major functional roles and courses of action.

What kind of benefits does HealthEquity offer for this position?

Benefits include medical, dental, and vision insurance, 401(k) matching, uncapped paid time off, tuition assistance, and wellness program incentives, among others.

Is there a performance-based incentive for this role?

Yes, this position will be eligible for performance-based incentives and restricted stock units as part of the total compensation package.

What industries might experience be preferred from candidates?

Experience in the HR service, financial services, or similar industries is preferred.

Are there opportunities for ongoing education and training?

Yes, ongoing education and tuition assistance are included as part of the benefits.

How does HealthEquity ensure an inclusive work environment?

HealthEquity is committed to inclusion and diversity, ensuring equal opportunity for all applicants without regard to various legally protected characteristics.

HealthEquity

Connecting Health & Wealth.

Finance

Industry

1001-5000

Employees

2002

Founded Year

Mission & Purpose

HealthEquity is a leading administrator of Health Savings Accounts (HSAs) and other consumer-directed benefits—FSA, HRA, COBRA, and Commuter. Benefits advisors, health plans, and retirement providers partner with us to help over 13 million members work toward long-term health and financial wellbeing. Visit HealthEquity.com to see our intuitive technology and remarkable service in action.