Director Configuration, Benefit Administration

This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC Duties & Responsibilities Develop and implement comprehensive operational strategies aimed at improving efficiency, productivity, and quality Lead initiatives to identify inefficiencies in current processes and procedures, recommending and implementing solutions to optimize workflows Identify opportunities for cost reduction and resource optimization while maintaining or improving service delivery and quality Work closely with department heads, project managers, and other stakeholders to align operational goals with organizational objectives. Facilitate collaboration to drive consistent improvement across the organization Support change management efforts related to operational improvement initiatives, ensuring successful implementation and adoption of new processes and technologies Identify potential operational risks and develop mitigation strategies to minimize disruptions and ensure smooth operations Drive flexible, repeatable and scalable benefit configuration design and implementation processes with industry best-practices Engage directly with other operational teams and leaders to provide input on the scope, approach, and timing of configuration work Assess upstream and downstream impact of configuration and policy changes to proactively identify and mitigate risk Manage interdependencies across other configuration units and business areas to ensure delivery timelines and project deadlines are met Identify and resolve inconsistencies between system configurations, regulation, contracts, and policies Maintain effective and consistent configuration testing protocols and quality controls Manage and monitor team performance, production and quality Establish structure for ongoing education, training and knowledge share across team Prepare and present updates to the business and senior executives on benefit configuration strategies, activities, and metrics Lead and support company-wide initiatives Work with internal and external parties to ensure benefit administration logic and business rules are well understood and administered appropriately Actively support all Compliance and Regulatory requirements with appropriate policies, processes, reports, and audit support. Additional duties as assigned. Minimum Qualifications Bachelor's Degree from an accredited institution or equivalent work experience HS Diploma or GED of accredited institution Proven ability to develop strong interpersonal relationships, as a leader and team member with experience communicating and influencing impact and progress to senior leadership level Successful track record developing creative, workable strategies and tactics to accomplish division, corporate and plan goals Preferred Qualifications Master's degree or MBA from an accredited institution Healthedge Configuration and Integration experience Proven experience in health insurance focused on claim configuration and reimbursement processes Proficiency in provider contract reimbursement terms and code sets (HCPCS, ICD10, DRGs, CPT, etc.), and claims processing practices Knowledge of medical claims and adjudication procedures, including the application of reimbursement and medical policy guidelines and contract pricing Knowledge of benefit administration and or claim payment methodologies and regulatory frameworks governing health plan reimbursement methods in Medicare, Medicaid and commercial insurance markets Experience leading complex, technical, cross-functional programs and working with senior executives Experience articulating complex issues to audiences with varying levels of technical expertise Experience influencing leaders, breaking down barriers and managing competing priorities Strong problem solving and analytical skills Compliance & Regulatory Responsibilities: N/A License/Certification: N/A WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. #J-18808-Ljbffr Healthfirst