Sr. Manager of Operations - Claims

UHS•Reno, NV

62d

About The Position

The Sr. Operations Manager is responsible for management of Prominence Health Plan operations and select vendor relationships. The Sr. Operations Manager will direct strategic initiatives to realize efficiencies, and outstanding customer service to Prominence Health Plan clients, brokers, vendors, providers and members as well as to ensure that operational goals and measures are met. Responsible for gathering and validating requirements, coordinating tasks, regular communication, identifying appropriate resources needed to development and implementation of significant initiatives within the organization in support of Senior Management. The Sr. Operations Manager oversees and manages the operational and strategic aspects of assigned projects and initiatives, tracks project risks, opportunities and issues in order to develop resolutions to meet quality and timeline goals and objectives. The Sr. Operations Manager will be responsible for managing of key operational departments and have responsibility across all three lines of business. Responsibilities also include being the lead operational liaison connecting market based leadership to centralized operations and support directing oversight of a remote workforce.

Requirements

Bachelor’s Degree in Business or related Health Care degree, MBA, or Masters in Public Health.
Five years of Operations Management experience working within the Healthcare Insurance industry required.
Knowledge of computer systems, experience using databases, and demonstrated proficiency in a variety of computer applications.
Working knowledge of NCQA process for standards applicable to UM/QI.
Ability to effectively communicate in English, both verbally and in writing.
Ability to convey goals and objectives clearly and in a compelling manner; listen effectively and clarify as needed; confirm all verbal messaging via written document; produce clear status reports; communicate tactfully and candidly.
Confidence in decision-making. Can-do attitude.
Excellent interpersonal, oral and written communication skills.
Strong analytical ability, excellent communication skills, with the ability to manage projects and multiple priorities at the same time.
Self-motivated and able to provide results with minimal supervision.
Experience in managing multiple project and reporting.
Must understand data specifications and requirements for reporting needs.
Experience in working with data, understand data structures/relationships, data field types, causes for data integrity and reporting issues.

Responsibilities

Management of Prominence Health Plan operations and select vendor relationships.
Direct strategic initiatives to realize efficiencies, and outstanding customer service to Prominence Health Plan clients, brokers, vendors, providers and members as well as to ensure that operational goals and measures are met.
Gathering and validating requirements, coordinating tasks, regular communication, identifying appropriate resources needed to development and implementation of significant initiatives within the organization in support of Senior Management.
Oversees and manages the operational and strategic aspects of assigned projects and initiatives, tracks project risks, opportunities and issues in order to develop resolutions to meet quality and timeline goals and objectives.
Managing of key operational departments and have responsibility across all three lines of business.
Being the lead operational liaison connecting market based leadership to centralized operations and support directing oversight of a remote workforce.