Director II, Claims Ops Transformation

Director II, Claims Ops Transformation (Dir II Digital Ops)

Location: This role requires associates to be in-office 3 days per week , fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Alternate locations may be considered if candidate resides within a commutable distance from an office.

The Director II, Claims Ops Transformation oversees a combined digital and operations unit(s); executes strategies to deliver industry leading digitized service results. Serve as a leader across departmental lines in order to further penetration of operational digitization, E2E efficiencies, lowered administrative costs and an excellent member and provider experience.

How you will make an impact:

• Lead digital transformation initiatives that improve claims operations and overall service delivery.

• Partner with leaders across the organization to implement strategic plans and shared goals.

• Leads overall strategic work streams for transformational priorities which requires significant accountability and management of numerous special projects.

• Plans, directs, and controls the resources and efforts within a blended Digital Claims Operations organization.

• Effectively manage the resolution of intra-organizational issues in the balanced best interests of the business.

• Executes objectives of the company and the blended Digital Ops organization

• Responsible & accountable for implementation / management of digitization initiatives that demonstrates understanding of current and future operational business processes that digitization does/can enable.

• Ensures compliance with state and federal regulations.

• Oversees strategic planning, budget development, and management for a single large or multiple cost centers, contract compliance, and any necessary integration of government regulatory requirements.

• Manages an enterprise suite of applications by developing digitization forecast and delivery plan.

• Ensures disaster recovery and business continuity plan are implemented, monitored, and updated on a recurring basis.

• Delivers operational guidance and offers system solutions that support the operations of their functional areas on a 24x7x365 basis.

• Plans and executes annual projects while maintaining profit and loss (P&L) responsibility.

• Develops a strong team through training and effective organizational development practices.

• Implements the policies, practices, and procedures of the company and blended digital and operations organizations.

• Manages direction of information system and programming activities of technical staff.

• Leveraging reporting and analytics tools, continually monitors procedures and operational metrics to ensure these are met by staff.

• Builds strong partnerships with market and digital leads, Benefits Administration, Provider Engagement and Contracting, Sales and Internal Audit.

• Hires, trains coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires an BA/BS degree in Information Technology, Computer Science or related field of study and a minimum of 8 years experience leading technology (application development, configuration, maintenance or implementation and support) teams and/or cross functional project (technology and operations) teams; or any combination of education and experience which would provide an equivalent background.

• Requires 7 years' management experience.

Preferred Skills, Capabilities, and Experiences:

• Proven experience leading large Claims Operations teams (100-200 employees) within a matrixed healthcare payer environment strongly preferred.

• Proven experience leading Claims Operations strategy strongly preferred.

• Digital literacy strongly preferred.

• Health insurance industry experience strongly preferred.

• Claims operational experience strongly preferred.

• Process Improvement/Six Sigma skillset preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $170,940 to $293,040.

Locations: California; Colorado; Illinois; Massachusetts; Minnesota; Nevada; New Jersey; New York; Washington

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact View email address on click.appcast.io for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration ( .