Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
If this sounds like you, read on!
The Senior Director of Health Claims Customer Service Operations will assume all operational responsibility and oversight for all lines of business within Virginia Premier. This includes monitoring daily incoming calls, portal inquiries, and any claims adjudication performed by the Customer Service team. Incumbent will ensure the Customer Service unit meets contractual metrics for Centers for Medicare and Medicaid Services (CMS) and the Department of Medical Assistance Services (DMAS). Will ensure the team has adequate tools and training of each lines of business to ensure claims are processing according to federal, state and individual contractual regulatory policies and guidelines. Will also be responsible for the creation or aligning of operation units to efficiently support the call center demands by ensuring the team has policies, standard operating procedures, process maps, metrics, etc. Will work closely with Virginia Premier’s program directors, compliance leadership and program integrity departments to ensure all programs are administered appropriately. This individual will also work with the entire internal claim departmental units to ensure areas are aware of the program statuses, modifications, system requirements, etc.
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE
Our mission is to inspire healthy living within the communities we serve!