Director Claims Operations Support (remote)

Sentara Health is seeking to hire a qualified individual to join our team as a Director, Claims Operations Support.

Position Status: Full-time, Day Shift

Position Location: This position is remote within our remote states in person is acceptable as well.

Standard Working Hours: 8:00AM to 5:00PM (ET).

Minimum Requirements:

• Bachelor’s degree required.
• 7 years Health Insurance experience required.
• 5 years management experience required.
• Solid background in Claims Operations.
• Skilled in large scale complex, health insurance operations.
• Technical experience.

Preferred Requirements:

• Master’s degree preferred.

Expectations for this Role:

Sentara Health is seeking a Director, Operations Support responsible for the coordination of all operational management activities related to the claims processing unit. The Director of Claims processing will be responsible for directing and coordinating all aspects of Health Plan claims processes. Works closely with the VP of Claims Operations and the Directors of all the Plan’s departments to effectively process and pay claims from providers and facilities in a timely manner and in compliance with federal and State regulations. Supervise and train managers of the Claims Department, and oversees all the department’s functions, leading the department to be able to handle a high volume of claims. Responsible for directing the planning, design, development, documentation, implementation and evaluation of policies and procedures that assure accurate, timely claims processing. Collaboration and communication with other departments on claims issues, related projects and inter-departmental operations issues and develop effective, actionable solutions. Responsible for managing all claims inventory and aging includes those in other areas through a collaborative approach to ensure timely payment.

Additional Expectations:

• Solid communication skills.
• Operate in a collaborative and cooperative environment.
• Ability to show initiative, good judgement, and resourcefulness.
• Experience with QNXT claims processing systems a plus.
• Knowledge of claims cost containment a plus.

This role will manage the claims managers.

Sentara Health Overview

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 130 years in pursuit of its mission - "We improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 30,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018), and was recognized by Forbes as a "Best Employer for New Grads" (2022), "Best Employer for Veterans" (2022), and "Best Employer for Women" (2020).

Mission, Purpose, and Values

• Mission – We improve health every day.
• Purpose – Sentara exists to be the trusted partner to individuals and the community in their journey to health and well-being.
• Values – People, Quality, Patient Safety, Service, and Integrity.

Sentara Healthcare Commitments

Sentara has made a commitment to its colleagues, patients, and members to:

• Always keep you safe.
• Always treat you with dignity, respect, and compassion.
• Always listen and respond to you.
• Always keep you informed and involved.
• Always work together as a team to provide you with quality healthcare.

Sentara Benefits
As the third-largest employer in Virginia, Sentara Healthcare was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:

• Medical, Dental, and Vision Insurance
• Paid Annual Leave, Sick Leave
• Flexible Spending Accounts
• Retirement funds with matching contribution
• Supplemental insurance policies, including legal, Life Insurance and AD&D among others.
• Work Perks program includes discounted movie and theme park tickets among other great deals.
• Opportunities for further advancement within our organization

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!

Please Note: Yearly Flu Vaccination are required for employment.

#indeed, #LI-AB1

For applicants within Washington State, the following hiring range will be applied: $126,999.60 - $167,643.84.

Candidates must have residency in one of the following states to work remotely in this position:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

Key words: Clinical Pharmacy, PBM, Director Pharmacy PBM, remote, managed care

• Bachelor's Level Degree

• Management 5 years
• Health Insurance Industry 7 years

• Project Management
• Quality Control Analysis
• Reading Comprehension
• Science
• Service Orientation
• Social Perceptiveness
• Speaking
• Systems Analysis
• Systems Evaluation
• Technology/Computer
• Time Management
• Troubleshooting
• Writing
• Active Learning
• Active Listening
• Communication
• Complex Problem Solving
• Coordination
• Critical Thinking
• Judgment and Decision Making
• Leadership
• Learning Strategies
• Mathematics
• Mgmt of Financial Resources
• Mgmt of Material Resources
• Mgmt of Staff Resources
• Microsoft Excel
• Microsoft Word
• Monitoring
• Persuasion