Director, Claims Operations

Location

Thornhill, ON | Canada

Job description

• Accountable for the effective and efficient operation and performance of the Claims team while demonstrating leadership, knowledge and application of industry/claims processing metrics, standards of practice, policies and procedures, quality improvement processes, and the goals of the organization. 

• Works professionally and effectively with all employees, in a high volume, fast-paced environment.  
• Communicates professionally on a regular basis with external clients, patients and providers.

• Manages staffing, scheduling, and procedures to ensure claim turnaround times that meet client SLAs. 
• Identifies how to raise performance levels and encourages others to work outside of their comfort zone by setting stretch goals and providing challenging and exciting assignments. 
• Coordinate resources and acts as a liaison between internal operations departments to ensure the client accountability objectives are effectively met. 
• Develops and applies methods to proactively identify, monitor and intervene as required on potential high dollar/problematic claims or potentially fraudulent claims. 
• Challenges the status quo by thinking out of the box and taking educated risks to improve team results.  
• Understands Company strategy and educates employees about it in a tangible manner.  
• Participates in sales efforts and new Client or up-sell implementations by appropriately analyzing the resource requirements, planning/designing the implementation education and operational needs, and executing accordingly. 
• Serves as a resource to the team to facilitate communication among patients, providers, clients and peers, and to monitor services rendered.  
• Assesses bottlenecks of work processes and coordinates with others to implement solutions aiming at increased efficiency and integration. 
• Establishes and grows working relationships and networks across departments and ensure employees share the information needed by others.  
• Makes sure employees have the necessary skills and resources to succeed.  
• Supports recruitment and selection process for local and international claims teams. 
• Adjusts own management style to each team member, taking into account his/her needs, interests, concerns and motivations, in order to bring the best out of him/her. 
• Actively participates in Company performance improvement process by evaluating and addressing issues with assigned staff within appropriate HR practices and principles.

Other

• Adheres to all policies and procedures as outlined in the Employee Handbook and client specific protocols. 
• Performs all work in a PIPEDA and HIPAA compliant manner. 
• Works in compliance with the Occupational Health and Safety Act and related legislation. 
• Performs Supervisory responsibilities as outlined in section 27 and 28 of the Occupational Health and Safety Act. 
• Ensures strict standards for claimant/client confidentiality and complies with organizational and governmental regulations/policies.  
• Other related duties as assigned.

4. YOUR KNOWLEDGE AND EXPERIENCE

• Minimum ten (10) years of relevant international medical claims experience at a Supervisory level. 
• Demonstrated experience with new process implementation or process improvement. 
• Provider network management experience an asset. 
• Excellent working knowledge of computer programs. 
• Superior verbal and written communication skills. 
• Experience with non-North American medical system an asset. 
• LOMA Certification(s) – ALMI, FLMI, ACS an asset. 
• Medical Terminology, clinical experience an asset.  
• Ability to speak multiple languages an asset.

5.   EFFORT AND WORKING CONDITIONS

• Discretion in dealing with confidential/sensitive information. 
• Critical and analytical thinking required. 
• Ability to guide and delegate when appropriate. 
• Negotiates to resolve disagreements that may arise with clients, patients, colleagues and others encountered during Company business.  
• Concentration and creativity required daily to develop strategies, create budgets, facilitate meetings, mediate conflicts, etc. 
• Works in a typical office environment and the noise level is moderate. 
• Sitting for long periods of time. 
• Exposure to constant interruptions/distractions, deadlines and multiple demands.  
• Works in a home office setup on occasion, only as required and at the discretion of the Company. 

Job tags

Salary