Director of Claims – Stop-Loss Transformation

🕒 il y a 2 mois

🏈 Ohio – Distant

🏈 Ohio – Remote

💵 $120 000 - $160 000 / an

⏰ Temps Plein

🔴 Expert

👔 Directeur

👻 Score fantôme 14%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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S&S Health

Site WebLinkedInTous les Emplois

51 - 200 employés

Fondée en 1994

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

S&S Health est un prestataire moderne de services d'administration de santé dédié à offrir des solutions de santé abordables aux employeurs et à leurs employés. En se concentrant sur la gestion des coûts, S&S Health aide les entreprises à réduire les dépenses de santé tout en maintenant des soins de haute qualité. Grâce à un support complet, ils fournissent des outils et des ressources pour garantir que les employés aient accès aux soins médicaux appropriés à des prix compétitifs, visant en fin de compte à améliorer à la fois les résultats de santé et le bien-être financier.

Description

• Lead strategic modernization initiatives that advance the future capabilities of our claims and stop-loss platforms. • Assess current-state capabilities, identifying operational gaps, designing future-state operating models, and leading complex initiatives. • Partner closely with Executive Leadership, Claims Operations, Stop-Loss, Technology, Finance, Compliance, Client Success, and operational teams to evaluate current performance. • Redesign workflows, establish accountability structures, and execute transformation initiatives that enable operational excellence. • Evaluate current-state claims and stop-loss capabilities, including processes, technology platforms, organizational structures, workflows, controls, compliance posture, and performance trends. • Conduct structured assessments and develop future-state operating models, transformation strategies, and implementation roadmaps.

🎯 Exigences

• Significant leadership experience within a third-party administrator (TPA), self-funded health plan, managed care, or health insurance organization. • Deep understanding of claims operations, stop-loss administration, employer-sponsored health plans, and healthcare administration workflows. • Experience with self-funded plan mechanics, ASO arrangements, stop-loss contract structures, and carrier relationships preferred. • Knowledge of employer group, broker, TPA, and stop-loss carrier dynamics. • Demonstrated success leading healthcare transformation initiatives, business process redesign, operational modernization, and enterprise change programs. • Experience developing future-state operating models, transformation roadmaps, and scalable operating processes. • Proven ability to identify operational gaps, define improvement opportunities, and drive implementation across organizational boundaries. • Ability to influence executive stakeholders and lead complex initiatives involving multiple business functions. • Experience partnering with Technology teams to implement workflow automation, platform enhancements, data improvements, and operational enablement solutions. • Strong understanding of healthcare administration systems, EDI transactions, claims workflows, and operational processes. • Experience improving claims accuracy, workflow efficiency, operational performance, and service-level outcomes. • Understanding of stop-loss administration processes, including specific and aggregate claims, filing requirements, recoveries, and carrier coordination. • Familiarity with healthcare compliance requirements, including No Surprises Act, ACA reporting, and Continuity of Care requirements preferred. • Strong analytical, strategic thinking, and problem-solving capabilities. • Excellent communication and stakeholder management skills. • Ability to translate complex operational challenges into actionable transformation strategies.