Global Delivery Lead – Claims Ops & Systems
Long-term Opportunity ( 8+ months with extension or conversion possibility )
Midwest Ideally – open, remote
Korn Ferry has been tasked in providing a large, well-known healthcare client with a Global Delivery Lead resource with specific healthcare, Claims Operations and Systems experience. Specifically, we are looking for a proven leader who has built and overseen offshore claims teams with specific KPIs, performance metrics, SLAs, and process improvements necessary for excellent customer satisfaction and experience. This delivery lead will need experience with effectively communicating issues / escalations to leadership and any external customers accordingly.
This Delivery / Capability lead ( Director + level ), will oversee the activities of all India based Commercial Claims Operations, Claims System Configuration, and Provider Data Management departments to ensure the prompt and accurate adjudication of claims; accurate claims system and benefits configuration; achievement of cost objectives and service level goals; provider data management and related downstream processes; collaboration with all other departments to ensure goals are achieved and compliance guidelines are met.
What You Will Do:
- Work with Korn Ferry to establish management / leads / supervisors in India
- Establish standards of performance, including training, policies and procedures, claims auditing and other performance measurement techniques.
- Oversee all activities related to claims processing.
- Primary oversight and responsibility for delegated claims functions performed by third party vendor, including claims processing and fulfillment.
- Oversee the coordination of procedures for administering the various benefit plans and provider contracts with all interfacing systems.
- Audit contract set-up and recommend changes based on results.
- Audit Provider fee schedules and pay classes to ensure accuracy and correct payment.
- Responsible for implementing and auditing benefit changes as related to claims processing.
- Responsible for monitoring Medicare changes as they relate to claims payment and methodologies, benefits and coding and billing.
- Develop and implement cost control measures.
- Identify any negative or positive trends and reconcile with solutions accordingly
- Oversight of the administration, configuration and ongoing maintenance of the Mount Carmel Health Plan claims adjudication system.
- Directs the review of business process changes impacting the claims system.
- Directs the implementation and continuous improvement of claims adjudication system management policies, standards and processes.
