Claims Operations Director – Appeals
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Job Description
Claims Operations Director overseeing LOA, STD, ADA, and/or LTD Appeals service teams at Alight Solutions. Developing strategies and enhancing service delivery for workforce health and financial security.
Responsibilities:
- Leading LOA, STD, ADA, and/or LTD Appeals service teams
- Developing strategy and business plans to deliver market-centric capabilities and processes
- Working with broader organization and external parties to identify and gaps and develop a plan to address
- Anticipating future trends and challenges, developing and implementing strategies to address opportunities
- Assessing and evaluated business/technology partners to integrate products on various platforms
- Developing and recommended Claims and Service level strategies and tactics
- Demonstrating expertise in accurate Appeals Claim Management
- Collaborating with peers and senior leadership to deliver exceptional service
- Managing Appeals departmental budget and plan effectively for responsible growth
- Enhancing the Claims team through regular business updates to ensure alignment with organizational goals
- Fostering a culture of trust within the team
- Establishing performance metrics with clear systems of measures and accountabilities that drive results
- Ensuring that an effective system of regulatory compliance and internal controls have been maintained
- Complying with applicable laws and regulations, and documented procedures that incorporated preventive and defective controls
- Partnering with Regulatory Compliance and Risk Committees
Requirements:
- advanced education, equivalent work experience, training, or DMEC certification
- 10 years in claims/appeals and 7 years leadership in absence management
- qualifications or experience in healthcare, rehabilitation, or a medical field
- Lean Six Sigma Certification and or formal Operations Strategy training
- experience in leadership of a team of Managers within Appeals
Benefits:
- health, dental and vision coverages starting Day One
- wellbeing programs
- retirement plans with contribution matching
- generous time off
- parental leave
- continuing education
- career growth opportunities
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