Dir II Administrative Operations (Hybrid)

American Medical Association

6d•Hybrid

About The Position

As the Director of Administrative Operations, you will ensure delivery of outstanding customer service and the development of operational requirements, process and technology that provide essential customer service outcomes. As a member of the AMAI leadership team and advisor to the GVP and General Manager of AMAI, identify and execute business-wide initiatives to set AMAI direction including new products, customer acquisition, and growth. This position requires a deep understanding of the overall operations of a life/health insurance company and must be well versed on the regulatory and contractual requirements that impact the life and health insurance industry.

Requirements

Bachelor's Degree is required. In business administration or related field, preferred.
10+ years of experience heading up an insurance operations team in a life and/or health insurance company, large brokerage or third- party administrator, required.
Experience must include customer service, underwriting/certificate issue, life/health claims adjudication, contract interpretation and compliance, training and business requirement development; Life, Disability, Medicare Supplement product experience, required
Proven success facilitating progressive organizational change and development
Utilize a strong mentoring, coaching, and influencing style to engage and lead across all levels of the organization; leads effective training programs to support compliance and customer service
Knowledge of customer service and call center processes; insurance administration and claims systems
Directly manage relationships with TPA clients, management team of insurance company partners and vendors that support business operations

Responsibilities

Oversee hiring, training, and performance management for Administrative Operations management team and their customer service (call center), claims, and operations teams
Facilitate and oversee the performance management process including setting department and individual goals, performance reviews, development plans and corrective action
Create a culture and processes to deliver a comprehensive and seamless service experience to all customers measured by satisfaction survey KPIs
Oversee education, coaching and training including systems, processes, contract interpretation, and industry issues (such as HIPAA, Fraud, Unfair Claim Settlement Practices)
Prepare department budgets and operate within budget expectations
Continually improve the customer experience by evaluating and redesigning system and business processes to enhance operational efficiency, increase productivity and drive engagement
Support new product opportunities by assessing operational feasibility of supporting the product, and identifying and creating workflow process and system requirements
Accountable for compliance with regulatory, legal and contractual requirements, enforcing effective policies and procedures that comply with state and federal insurance regulation
Function as the Subject Matter Expert on insurance company guidelines, including an in-depth understanding and ability to interpret and apply insurance contract provisions to business processes, carrier manuals and procedures, and standard insurance industry business practices
Review and respond to escalated issues – complaints to regulators and AMA/AMAI executives
Liaise with insurance carrier partners, TPA clients and vendors to ensure AMAI meets administrative obligations
Provide support for all internal and external audits.
Function as AMAI liaison for interactions with the AMA Facilities Management Department