Director of Claims – Northwest Physicians Network – SeaTac, WA

Director of Claims.

OptumCare is a network of health care providers in local markets whose mission is to help providers deliver the most effective and compassionate care to each patient they serve. OptumCare’s primary focus is on doing the right things for patients, physicians, and the community. It uses an innovative service model focused on measuring what matters and increasing efficiency and performance while providing the highest level of customer service. This model allows OC to make a difference each day by delivering highly personal, customized care management to its patients.

OptumCare is succeeding at helping people live healthier lives by taking a different approach to health care. OC uses a commonsense approach, focused on avoiding jargon, finding more efficient ways to operate, and providing great, in-the-moment service. We provide that service by making sure serving our patients and providers is always the first priority. Each department works from the same central idea: “How does this affect the service we provide?” Because of the extreme commitment to service, OC focuses on recruiting passionate employees who will take advantage of being empowered to provide the highest level of service at each and every step.

Job Summary:

The Director of Claims will be accountable to identify and generate value, scalability, providing expertise on claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. The Claims Director will also be responsible for developing, translating and executing strategies for claims functional area while partnering with other functional areas.

This role will require direct collaboration and influence with senior-level leaders across OptumCare to drive ideation, strategy, execution and delivery.

Major Responsibilities:

• Builds trust, confidence and respect with senior leaders at the local leadership level and across OptumCare to generate value.
• Demonstrates courage to work in a highly ambiguous environment and adapts to changing internal or external dynamics as the operating model evolves.
• Demonstrates a self-starter attitude and is eager to experiment, invites and explores the potential in new ideas while understanding and mitigating the risk to the organization.
• Builds new solutions and/or modifies existing solutions that generate value, scalability, control, risk mitigation and/or a unified experience to customers.
• Communicate effectively with all level of staff and leadership ensuring messages appropriately tailored to audience whether delivered verbally or in written format.
• Leads key strategic initiatives and provides program leadership for large, complex programs in order to ensure programs and strategies are implemented and maintained effectively.
• Build relationships and leverages a network of experts – internal and external – that enhance innovation and performance.
• Identifies and leverages solutions/tools/processes deployed in individual business units that can be utilized at scale across the enterprise.
• Removes obstacles and manages remediation of business problems that impact delivery of products, customer satisfaction, and quality.
• Informs/influences key stakeholders on significant business or client risks even when others are responsible for course of outcome
• Manages cross-functional communications across Optum stakeholders as new solutions are identified and implemented.
• Identifies and builds value roadmaps in collaboration with senior leaders.
• Conducts data analysis with the intent of guiding strategies and plans.

Qualifications (List minimum work experience, educational background, professional licenses, certifications and skills required to perform the job):

Required:

• Bachelor’s degree or equivalent experience required; Master’s degree preferred.
• 5+ years of leadership experience including leading operations and/or business process improvement initiatives, integrating the voice of internal and external constituents, preferably in a claim’s environment.
• Demonstrable entrepreneurial skills (accountable for risk from ideation to execution).
• Proven ability to drive a cross-functional team that produces value.
• Strong leadership skills with proven ability to foster and manage senior-level relationships in a highly matrixed environment.
• High emotional intelligence.
• Superior verbal and written communication skills.
• Ability to influence with and without direct management/authority.
• Superior customer/consultant relationship management and collaboration skills.
• Healthcare industry experience.
• Ability and willingness to travel up to 20% of the time.