Director Financial Operations Payment Integrity Operations

Anticipated End Date:

Position Title:

Director Financial Operations - Payment Integrity Operations

Job Description:

Director Financial Operations Payment Integrity Operations

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.

Alternate locations may be considered if candidatesresidewithin a commuting distance from an office with ideal candidates being located in Eastern or Central Time Zones or willing to work Eastern or Central Time Zone Business Hours.

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.

The Director Financial Operations is responsible for coordinating directing and managing key operational functions supporting Payment Integrity Operations. This Director provides leadership across operational analytical project and technical areas using data and business insights to drive operational and process excellence improve workforce and inventory effectiveness and support strategic priorities.

Serves as a key liaison between upstream and downstream business partners to ensure operational alignment effective communication and successful execution of cross-functional initiatives. Provides oversight of departmental initiatives inventory management and operational reporting while partnering closely with Payment Integrity Strategy Product and Digital teams to align strategic priorities with operational capabilities readiness and execution. Leads and participates in cross-functional and enterprise-wide initiatives and serves as a key partner to business technology and senior leadership.

How You Will Make an Impact

Primary duties may include but are not limited to:

• Counsels senior management on enterprise-wide policies and strategies and provides operational insight regarding performance risks business impacts remediation plans and go-forward strategies.
• Represents the company in legal matters and testifies as needed.
• Develops and implements vision strategies and tactics to maximize the departments effectiveness while minimizing costs with a focus on operational and process excellence workforce and inventory management and opportunities to improve workflows through data and technology.
• Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.
• Works with other areas to develop solutions to complex operational problems and participates in critical interactions with both internal and external customers. Partners across operations data technology and other business areas to identify root causes improve processes and support enterprise initiatives.
• Hires trains coaches counsels and evaluates performance of direct reports and provides leadership across multidisciplinary operational analytical project support technical automation and quality functions.
• Serves as the primary operational liaison across upstream and downstream partners collaborating with Payment Integrity Strategy Product and Digital teams to align strategic priorities with operational needs identify dependencies influence solutions and support implementation readiness and end-to-end execution.
• Provides oversight of departmental initiatives coordinating priorities milestones deliverables risks and cross-functional dependencies to drive accountable execution of operational process and technology improvements.
• Leads departmental inventory management and reporting maintaining visibility into inventory health workload productivity performance trends and operational risks to inform leadership decisions resource planning and continuous improvement.
  

Minimum Requirements:

Requires minimum of 8 years experience with operations financial reporting and analysis audit guidelines budgeting and multi-state operations and processes and a minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background.

Preferred Skills Capabilities & Experiences:

• Payment Integrity experience with a strong understanding of claims operations operational workflows and the mechanics of Payment Integrity work preferred.
• Strong data and analytical fluency including experience using reporting inventory analytics and performance data to identify trends diagnose operational issues and support decision-making preferred.
• Operational and process excellence experience including the ability to evaluate workflows identify root causes and determine whether opportunities are related to training process goals or technology preferred.
• Experience leading in a complex healthcare operations environment with demonstrated agility responsiveness sound judgment and the ability to manage multiple competing priorities preferred.
• Experience leading or partnering across multidisciplinary functions such as workforce management project support reporting and analytics technology automation and quality preferred.
• Strong executive-level written and verbal communication skills with experience translating operational performance risks remediation actions and go-forward plans for senior leadership preferred.
• Experience across multiple healthcare lines of business another health plan or Blue plan or a Payment Integrity vendor environment preferred.
• Experience supporting enterprise-level projects and/or managing operational vendor relationships preferred.
• Knowledge and application of Lean Six Sigma or comparable continuous improvement principles preferred.

For candidates working in person or virtually in the below location(s) the salary* range for this specific position is $138320.00 to $238602.00.

Locations: Columbus OH; Connecticut Illinois; Maryland; Massachusetts; New Jersey; New York; and Virginia.

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 paid time off stock or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

Job Level:

Director

Workshift:

Job Family:

AFA > Financial Operations

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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. 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 .

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.

Required Experience:

Director