Vice President, Claims Administration

Summary

Under the direction of the Executive Vice President, Finance and Chief Financial Officer, this position is responsible for directing all claims administration for BHS. Directly supervises and is responsible for departmental staff and operations.

Specific Duties:

Under the direction of the Executive Vice President, Finance and Chief Financial Officer:

  1. Directs and oversees the operations of all claims administration functions at BHS to meet the company’s operational and financial requirements.
  2. Provides direction, supervision and support to all claims staff including directors of claims administration and all claims analysts in each division. Responsible for retaining valued staff and replacing or hiring critical staff when applicable. Develop staff capabilities to ensure coverage, cross-training and ongoing development through evaluation and continuous feedback.
  3. Plans, develops and implements projects, processes and technology to continuously improve and manage all claims administration operations and all related processes to continuously improve and manage its cycles and increase profitability.
  4. Manages and directs the systems and processes for efficient and accurate claim reporting, billing and processing. Responsible for working with CIO and other IT staff on process improvement and optimizing the use of technology to automate. If applicable, lead installation of new or revised in-house claims systems.
  5. Collects, organizes, analyzes and disseminates data reporting from various sources to management on a regular basis with attention to detail and accuracy including timeliness. Monitors reporting and escalates issues to EVP/CFO.
  6. Prepare quarterly and/or annual reports for clients. Responsible for pulling appropriate reports from a variety of software applications, analyzing data and preparing written comments. Keep abreast of client cost and advise other departments appropriately.
  7. Prepare departmental objectives, goals, workforce plans, budgets and recommend policies as appropriate.
  8. Recruit and supervise data entry staff as appropriate.
  9. Perform other related duties as directed or deemed appropriate. Attend meetings as requested.

Qualifications:

  • Bachelors in Accounting or a related field;
  • Five years insurance and/or healthcare experience, preferably with billing and/or claims experience required;
  • Some experience/involvement in mental health field preferred;
  • Very strong proficiency with computerized applications (Word, Access, Excel);
  • Experience managing projects for improving processes or implementing new systems for billing and other related business processes.
  • Excellent communication skills (written and oral) and organizational skills.

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