Director – Business Claims Analysis

Director – Business Claims Analysis

Requirements

• Bachelor’s degree in related field.
• 8+ years of experience in at least three of the following: process improvement/transformation, business/financial analysis, external consulting/auditing/risk analysis, customer journey/experience, organizational change management, IT solution/architecture, project management.

Responsibilities

• Manage a team responsible for identifying and implementing solutions for business optimization.
• Leads a team of professionals in guiding the business to achieve operational efficiency.
• Provides coaching and mentoring to develop associates including career pathing within the department.
• Leverages superior knowledge of healthcare, Centene, business improvement/transformation, organization change management, customer experience, and strategy, to provide training and enforcement of the eBT methodology tools and techniques.
• Establishes true partnership through learning the business / technology, building trust, and providing value.
• Provides guidance, leadership and encourages collaboration with Senior Management.
• Partners with senior management and seeks identification of new initiatives including scope, problem statement, stakeholders, and expected outcomes necessary to guide portfolio prioritization.
• Leads execution of an Enterprise Prioritization Assessment where applicable.
• Demonstrates thought leadership through out of the box thinking and leveraging deep Centene knowledge of business processes and systems.
• Leads highly complex or sensitive initiatives, which may involve Legal / Compliance or results in significant organizational, process, and technology impacts.
• Ensures appropriateness of overall initiative scope, multi-year strategy, and implementation plan to achieve operational efficiency and deliver excellent customer experience.
• Ensures establishment of a governance framework elements including strategy map, policy / procedure, balanced scorecard and operational reporting, problem and escalation management, risk and compliance mitigation, resource / vendor management, and training / communication for assigned initiatives.
• Oversees the measure to validate and ensure completeness, accuracy, and value add in support of superior quality product delivery.
• Ensures proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios.
• Produces executive level reporting demonstrating department goals achievement including ROI, on-time delivery, internal customer satisfaction scores.
• Acts as a change agent and strive to build unity at a time of change.
• Applies project management techniques to ensure on-time, high-quality deliverables.
• Performs other duties and special projects as assigned.

Preferred Qualifications

• Organizational Change Management (PROSCI, Six Sigma CAP, Kotter, Bridge’s Rogers Kubler), CEX, CMMI, Six Sigma, PMP preferred