Director, Claims Operations
Director, Claims Operations
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Job Description
Summary
Position Purpose: Responsible for the effective and efficient control of all claims processing and/ as well as oversight of the CGS Document Management Center. Develops and executes strategic and operational business plans for the department
Description
Logistics: CGS () one of BlueCross BlueShields South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at One Century Plaza - 26 Century Blvd. Suite ST610 Nashville TN 37214.
What Youll Do:
Provide direction and management for all activities for the department.
Support and develop operations management by establishing performance objectives and developing plans designed to strengthen management skills.
Review and analyze all business or contract directives to assure a clear understanding of the requirements.
Ensure compliance with all applicable laws regulations and contract requirements while meeting performance expectations through the establishment and implementation of effective management controls.
Direct major system enhancements and required changes in an effective and accurate manner.
Track monitor and analyze all productivity and quality performance measures to assure adherence to established requirements and to assess adherence to contract requirements.
Direct customer interaction for direction evaluation and modification of processes.
Provide ongoing leadership guidance and direction to all staff.
Improve the effectiveness of the quality management system by ensuring the International Organization of Standardization (ISO) requirements are met customer expectations are satisfied and preventive and corrective actions are identified and implemented.
Manage budget to maintain high quality and cost effective processes that fulfill business requirements.
Develop technical proposals and solutions for procurement of future contracts.
Responsible for supporting new business development to ensure long term growth and sustainability of the operation.
To Qualify For This Position Youll Need The Following:
Required Education: Bachelors degree
Required Experience: Seven years of claims processing or related insurance experience including either 3 years of management experience OR 3 years of equivalent military experience in grade E4 or above.
Required Software and tools: Microsoft Office
Required Skills and Abilities: Excellent communication analytical problem-solving and time management skills. Strong critical thinking and decision-making abilities. Comprehensive knowledge of claims processing and related support systems. Good organizational and customer services skills. Basic business math proficiency. Excellent personal computer skills. Ability to handle confidential or sensitive information with discretion.
We Prefer That You Have The Following:
Experience working on Government contracts
Experience with Durable Medical Equipment (DME) and / or Document Management Center (DMC)
Our Comprehensive Benefits Package Includes The Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies theaters zoos theme parks and more
What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.
What To Expect Next:
After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age race color national origin sex religion veteran status disability weight sexual orientation gender identity genetic information or any other legally protected status. Additionally as a federal contractor the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment please email or call ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Required Experience:
Director
Employment Type
Full-Time
