Share this Job

Director, Insurance Operations

Apply now »
Apply now

Apply for Job

Date: Mar 26, 2017

Location: East Lansing, MI, US

Company: The Doctors Management Company

A member of the Insurance Operations Department’s leadership team, the Director of Insurance Operations has two primary responsibilities – leading the Claims Service Team and delivering strategic projects focused on supporting the Claims Department.

 

The Claims Service Team delivers best-in-class customer service and efficient responses to member claim reports.  The Director is responsible for ensuring the team is meeting its service level agreements and quality standards. This individual will motivate the team to deliver top-notch performance and coach team members as they develop their skills and advance in their roles.

 

This role will also be responsible for leading technically complex projects related to making claims operations more effective and efficient, including coordination with the IT department to develop corresponding system support. In addition, the Director will conduct moderately complex operational analyses using a variety of tools, including Excel, Business Objects, Zendesk, and Qlikview.

 

RESPONSIBILITIES:

  • Responsible for day-to-day oversight of the Claims Services Team
  • Plans, organizes and directs work activity to efficiently provide quality service to customers
  • Responsible for understanding all tasks and activities performed by respective team members
  • Supports the development and delivery of training courses for the team
  • Assesses individual staff and team training needs and guides staff development accordingly
  • Ensures proper Claims Service Center coverage and proper processing coverage based on current in-bound volume and seasonal trends
  • Conducts audits and reviews of call recordings and processing performance
  • Researches and reports systems issues related to claims forms, claims processing, and records management and collaborates with IT staff in resolving those issues
  • Serves as an resource for special projects and UAT support
  • Mentors staff in the handling of phone calls, mail and faxed service requests, claims intake, claims set-up, and billing processes. 
  • Participates in the collection, reporting and analysis of data related to assigned business responsibilities and ensures quality member service results through routine productivity and efficiency monitoring
  • Assists with implementation of corporate and claims policies, goals and objectives.
  • Responsible for human resources issues and practices for assigned staff, including, but not limited to:  interviewing, selecting, and training, managing, monitoring performance, and providing feedback and job performance evaluations.  Addresses and attempts to resolve employee complaints and concerns, or refers to upper management and the Human Resources Department
  • Identifies potential operational or system enhancements that can improve operational effectiveness or efficiency for the entire Claims Department
  • Develops detailed business plans to support proposals, including detailed financial or operational analyses
  • Leads initiatives/projects on behalf of the entire Claims Department and Insurance Operations
  • Performs other duties as assigned

 

 

EDUCATION AND EXPERIENCE REQUIRED:

  • Bachelor’s degree or equivalent, preferably in Business, Management or related field
  • A minimum of five (5) or more years of professional liability or health care insurance
  • Five (5) or more years of professional liability claims experience required with a minimum of three years in medical malpractice
  • Five (5) or more years of experience in customer service required

 

SKILLS/KNOWLEDGE/ABILITIES REQUIRED:

  • Excellent oral and written communication skills.
  • Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures or governmental regulations.
  • Ability to write reports, business correspondence, and procedure manuals. 
  • Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public
  • Ability to apply concepts of basic algebra such as discounts, interest, commissions, proportions and percentages.
  • Ability to solve practical problems and deal with a variety of set variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
  • Hands-on knowledge of claims handling, customer service phone call handling, and related policy administrative tasks required.
  • Demonstrates leadership skills in organizing and prioritizing multiple responsibilities in a fast paced and changing team environment.
  • Ability to access, use and manage information via NOVA, Word, Excel, Power Point, the Internet and on-line rating tools.
  • Proficiency in use of phone systems including ACD.
  • Ability to travel and to adapt to a flexible work schedule.


Nearest Major Market: Lansing

Job Segment: Manager, Medical, Operations Manager, Management, Healthcare, Insurance, Operations