Senior Regional Operations Director

Job description

JOB SUMMARY: The Senior Director manages the day-to-day professional and facility medical claims on and off shore operations, including the medical claims intake, processing, quality assurance, revenue recovery, and provider/member call center activities in accordance with established plans, standard operating procedures, and legal and regulatory requirements. Reports to Vice President, Financial Risk Management, VBC, and assists in developing, implementing, and monitoring of the professional and facility medical claims operational plans, goals, and objectives. The Senior Director makes all daily operating decisions of the claims operations according to established plans, policies, and standard operating procedures. Refers issues that could severely impact the organization reputation or financial conditions to the Vice President, Financial Risk Management, VBC. Recommends future plans, programs, and changes to the Vice President. Establishes policies for department heads so that decisions on specific daily operational issues can be resolved in an effective manner. ESSENTIAL DUTIES AND RESPONSIBILITIES: Include the following. Others may be assigned. Ensures a high level of morale an...