In the highly visible role of Senior Director Claims you will be responsible for management of claims payments for all Lines of Business(LOB), which require separate reporting and monthly submission to state and federal regulatory agencies. This role is intricately involved in key health plan projects such as Encounters, Auto-Adjudication Improvements, Contract Implementation and testing. Our ideal candidate will be a subject matter expert with Claims experience in the Medicare and Medicaid payment rules. You will be an experienced leader with a proven track record in execution and influence at the highest level, as we continue to transform as an organization in innovation.
Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package. Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.
POSITION SUMMARY This position is responsible for driving and supporting the insurance division programs and processes, with focus on quality of outcomes and superior service. Promotes a collaborative, open, and inclusive work environment within a highly matrixed organization. This position serves as the primary advisor to the organization's senior management on matters related to claims functions. Monitors and oversees compliance, customer service, stakeholder relations, workforce, and financial goals and objectives as developed by the Board of Directors and senior executive management. This position is responsible for serving as a role model to staff across the system and representing Banner in a positive manner both within and outside the organization.
CORE FUNCTIONS 1. Guides the development and implementation of short and long-range goals and objectives for the insurance division's claims operations. Provides leadership and expertise in the development, implementation, oversight, and evaluation of claims programs and associated workflows for the system. Incorporates best practices and responds to emerging trends to enhance operations, programs, and/or services. Implements and evaluates strategic programs, develops effective tools to measure performance, analyzes related data, prepares reports, and makes recommendations to senior leadership based on findings.
2. Directs, supervises, and evaluates the work of leaders. Holds leaders accountable for achieving initiatives and performance targets. Works with leadership and staff to identify and resolve the most complex issues and problems impacting claims adjudications and operations. Develops and leads career development opportunities professional growth to meet company and individual goals for long-term success. Demonstrates an expectation for continuous quality improvement utilizing processes that include consideration of all stakeholders.
3. Builds and supports effective relationships with internal and external stakeholders and organizations. Develops partnerships, coordinates activities, reviews work, exchanges information, and/or resolves problems related to claims functions and related programs. Is an active participant in professional organizations to promote continuing education and development of both themselves and their leaders.
4. Directs and participates in the development, procurement, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.
5. Develops and oversees the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance. Manages and reports expenditures.
6. Communicates the department vision, translating it into actionable projects and activities. Maximizes management staff's contributions and assures timely decision-making reflecting the mission, vision, and values of the system.
7. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.
8. Participates as a subject-matter expert and may lead or facilitate audits, task forces, teams, and/or councils to plan, implement and coordinate programs, services, and/or activities for the organization. May serve as a staff resource to the organization's Governing Board and/or applicable committees.
9. This position has direct leadership accountability for all aspects of the insurance division's claims operations. This position requires the skill to negotiate and influence. Customers of this position are both internal and external, including leadership, staff, medical staff, regulatory agencies, and/or the community. The scope of this position is broad and complex due to the responsibility and accountability for the claims functions across the insurance division. The internal customers include all levels within the organization. The external customers are members, providers (including their office staff), regulatory agencies, insurance plans and payers.
Bachelor's Degree in a relevant field or equivalent level of education and experience.
Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver's License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.
Expert-level working knowledge of principles, practices, and operations in assigned or related area of responsibility as normally obtained through a minimum of five years of progressively responsible managerial experience, including a minimum of two years management level experience within a healthcare system setting or large multi-operational, complex corporate environment. Must demonstrate expert-level knowledge and awareness of area of expertise in designated facility, business entity or area and/or experience in which the knowledge, skills, and abilities are directly transferrable. Proven track record of driving successful performance outcomes and accomplishing organizational goals. Must demonstrate skills and business acumen through direct leadership experiences such as: Anticipating and responding to the needs of internal and external customers; managing a budget and financial plans; building partnerships with management, staff, and stakeholders to achieve department goals and objectives; managing problems and situations where uncertainty is inherent; persuading others to adopt a particular stance on an issue; developing and evaluating best practices and emerging trends for organizational applicability and appropriateness; constructing new and innovative solutions for complex and varying problems and situations while considering the larger perspective or context; mentoring and coaching staff by providing open and honest feedback to enhance performance; developing and implementing strategic goals and initiatives that support organizational success; demonstrating excellent human relations, organizational and communication skills; demonstrating a passion about continuously improving and providing high quality care and service excellence to customers, patients, families, employees and/or physicians.
Additional related education and/or experience preferred.
What might draw you to Banner Health? A great health care career, of course—and a great place to live, no matter what stage of life you’re in. With facilities across the West, there is a health care career for everyone, from big city living in the Phoenix area to friendly small towns in the mountains and plains. As one of the largest nonprofit health systems in the country, Banner Health offers both the stability that comes with success and the possibility of exploring new areas of the country. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages:
Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health.
Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible.
The size, success and growth of our system provide you with the stability and options to pursue your desired career path.
Competitive compensation and comprehensive benefits offer you options to complement your unique needs.