Lead Director, Provider Claims Experience

CVS Health•Hartford, CT

About The Position

Provides strategic leadership and oversight to ensure exceptional customer claim experiences and satisfaction by developing and implementing service strategies, managing a team of customer service representatives, monitoring service quality and performance metrics, resolving escalated customer issues, and implementing customer service training programs. Applies leadership skills, customer-centric mindset, and problem-solving abilities to drive customer loyalty, retention, and advocacy while promoting a positive and service-oriented culture within the organization. Through structured provider engagement and claims payment review discussions, the role secures resolution of open inquiries and issues, elevates areas of ongoing opportunity to key cross-functional partners, and contributes to an overall improved provider experience.

Requirements

5-7 years of experience in claims / provider operations
3-5 year of experience with managed care claims processing and/or provider payment dispute resolution and relations
Prior experience leading cross-functional operational workflows with SLAs
Strong written, verbal, and project management skills, including provider-facing discussions
Ability to drive accountability across multiple stakeholders and resolve dependencies in a high-urgency environment
Bachelor's degree preferred/specialized training/relevant professional qualification.

Responsibilities

Develops / maintains effective working partnership with appropriate points of contact within key health system partners related to revenue cycle, accounts receivable management, and contracting as appropriate
Develops strategies to optimize service operations, ensuring the efficient and effective delivery of services to meet customer needs and expectations.
Implements industry best practices and proven methodologies to streamline service processes and improve operational efficiency.
Evaluates, selects, and integrates innovative technologies and systems to optimize service operations and enhance customer support efforts.
Oversees all claims through completion within defined SLAs and holds stakeholders accountable for closing/advancing claims within established SLAs.
Manages and allocates resources effectively to ensure that services are delivered efficiently, on time, and within budget.
Develops and monitors key performance indicators (KPIs) to measure service performance, ensuring that the services provided meet the established quality standards and customer expectations.
Fosters a customer-centric culture, emphasizing empathy, effective communication, and problem-solving skills in all customer interactions.
Focuses on customer satisfaction and retention by monitoring customer feedback, addressing complaints, and implementing measures to enhance the customer experience.
Communicates strategically with IT and data management teams, leveraging technology and data analytics to optimize service operations, improve efficiency, and enhance customer insights.
Stays updated on industry trends, emerging technologies, and best practices in service operations, incorporating relevant knowledge into operational strategies and driving innovation in service delivery.