Assistant Director of Claims & Participant Services in Burbank, CA at Volt

Date Posted: 8/27/2018

Job Snapshot

  • Employee Type:
    Direct Hire
  • Location:
    Burbank, CA
  • Job Type:
  • Duration:
    N/A
  • Date Posted:
    8/27/2018
  • Job ID:
    134520
  • Contact Name
    Volt Branch

Job Description

The Assistant Director of Claims and Participant Services assists in providing strategic leadership and daily oversight of several claims processing and phone functions, both within the business and those performed by outside outsourced vendors. This role assists the Claims Director in making day-to-day operations management decisions, involving the development, implementation, and assessment of long-range and short-term goals. 

ESSENTIAL JOB FUNCTIONS:

  • Analyze department operating reports and adjust departmental procedures accordingly, and find solutions for continuous improvement
  • Analyze, benchmark and drive conversion and customer satisfaction metrics
  • Assist Claims Director in the prioritization of projects, assist in the allocation of available/needed resources to ensure completion of projects and process implementations timely and accurately, for claims and enterprise level projects
  • Assist with the development and implementation of system flows to improve auto-adjudication of claims payment processes
  • Assist with the development of short/long-term customer service objectives and continuously monitor procedures to ensure managers meet expectations
  • Work collaboratively with other departments to resolve issues and barriers
  • Develop strategies regarding future needs and enhancements that align with company goals
  • Engage in receiving calls and inquiries, investigating, evaluating, and settling complaints and claims of customers
  • Proactively work towards reducing customer complaint drivers
  • Ensure customer and staff understand Health Plan rules and regulations and follows up on customer interactions
  • Excellence in building teams, developing people, cultivating long-term customer relationships, and role models service excellence
  • A deep commitment to creating an environment of continuous learning and improvement with focus on improving customer service
  • Lead planning efforts to scale the contact center to handle a changing volume and complexity of incoming customer interactions
  • Manage effective work force planning and optimization of staffing resources
  • Lead and coach staff to accomplish key deliverables such as high quality audit results and timely turnaround time
  • Monitor staff performance in conjunction with Managers
  • Perform additional functions that may be assigned at the discretion of management
  • Prepare and conduct performance reviews of Managers and their direct reports
  • Provide direction in order to achieve goals and objectives through interviewing, coaching and counseling, developing and training, motivating, evaluating and role modeling
  • Assist with overseeing claims processing procedures, reviewing and recommending appropriate action on problem claims
  • Work with the Claims Director to preserve the integrity of the Plan’s Summary of Benefits, ensuring all pertinent information is correctly included in revisions or changes, and communicated to Participants within regulatory timeframes (Summary of Material Modification – SMM)


QUALIFICATIONS:

  • Possess background in group health claims processing and a thorough working knowledge of typical union eligibility requirements, 2 years of leadership at the supervisory/management level
  • A college degree preferred and five or more years of group claims/call center experience required
  • Possess skills to communicate effectively with staff and outside correspondents
  • The ability to organize, adjust and reorganize with definitive analysis of personnel and department and procedural needs
  • Two to five years managerial experience and professional schooling regarding group health claims or trust fund management
  • Knowledge of claims coding and terminology (ICD-9/10, CPT-4, DME codes)
  • Experience with system implementation, migration, and/or management
  • Experience leading and scaling small to large call centers
  • Familiar with Customer Relationship Management (CRM) products
  • Preferred experience with Cisco, TASKE, and NICE systems

Volt is an equal opportunity employer