Share this Job

 

 

 

 

 

DIRECTOR CLAIMS AND OPERATIONS

YONKERS, NY, US


Lead a large scale organization accountable for the accurate, timely and efficient processing of Claims.  Set the strategic vision and objectives of the claims department, drive innovation, higher operational performance and quality outcomes.

 

  • Set the strategic claims vision in compliance with federal, state and organization guidelines
  • Leverage industry best practices, technology innovations and process redesign elements into the strategic vision of claims to support the continued growth of the organization
  • Direct day to day operations of the claims department and ensure that claims are processed within established government and company guidelines
  • Empower the claims leadership team and support the department and ensure quality claims metrics and service level agreements are met
  • Collaborate with executive leadership from cross functional departments to ensure efficiency and proper prioritization of the claims adjudication process
  • Assist with strategic direction and maintenance of QNxet claims system - maximizing system capabilities for efficiency and smooth claims transaction processing 
  • Develop production and quality standards and ensure that stretch goals are established to drive sustainable long-term quality and efficiency models
  • Set service levels and increase real time prioritization and productivity capabilities
  • Drive innovation toe establish, evaluate and implement processes and procedures to accomplish the organization’s and department’s objectives
  • Ensure compliance with all state and federal claims payment regulations and guidelines

 

Bachelor’s degree in Business Administration, Management, or Finance; Master’s degree preferred.  10 years of experience in overseeing and developing claims operations preferably in a managed care and or Medicaid setting.  Previous management experience including responsibilities for hiring, training, assigning work and maintaining performance of staff.

 

 

Department: CMO Bargaining Unit: Non Union Campus: YONKERS  Employment Status: Regular Full-Time Address: 100 Corporate Blvd, Yonkers
Shift: Day Scheduled Hours: 8:30 AM-5 PM Req ID: 135178 

 

Montefiore is an equal employment opportunity employer. Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law. 

 

#GDDA; #LI-TM1 


Mission:
To heal, to teach, to discover and to advance the health of the communities we serve.

Vision:
To be a premier academic medical center that transforms health and enriches lives.

Values
Define our philosophy of care, they shape our actions and motivate and inspire us to pursue excellence and achieve the goals we have set forth for the future. Our values include:

  • Humanity
  • Innovation
  • Teamwork
  • Diversity
  • Equity

 

 

 


Nearest Major Market: Yonkers
Nearest Secondary Market: New York City