Technical Services and Claims Director

Logistics:

This is a full-time position working (40-hours/week) Monday-Friday 8:00am - 5:00pm on-site at One Century Plaza in Nashville, TN, in an office environment with occasional travel.

What You'll Do:

• Provides oversight and management to the claims and/or other operational units. Ensuring all timeliness and quality metrics required are being met or exceeded.

• Develops and executes strategic plan to ensure contract obligations are being met. Develops and monitors budgets and resources.

• Track, monitor and analyze all productivity and quality performance measures to assure adherence to established requirements and to assess adherence to contract requirements.

• Direct customer interaction for direction, evaluation, and modification of processes.

• Provides technical oversight and coordination with Technical Teams, including overall project management to ensure that applicable Change Requests and Technical Direction Letters are being implemented timely and accurately.

• Ensures that all systems are operational and fully meet the needs of the MAC contract.

• Accountable for directing the testing of standard systems release modifications for responsible functional area and their interfaces with external systems.

• Ensures applicable internal systems files and tables are maintained according to regulations and claims processing procedures.

• Communicate changes to affected business units.

• Provides project management oversight, guidance, knowledge, and technical expertise for all departments with the MAC contract.

• Identifies potential risks and develops mitigation strategies to ensure project success.

• Maintains clear and effective communication with stakeholders to ensure alignment and transparency.

• Assists with all system changes and ensures all contract obligations are being met.

• Develop technical proposals and solutions for procurement of future contracts.

• Responsible for supporting new business development to ensure long term growth and sustainability of the operation.

• Develops and monitors budgets and resources for all assigned areas. Responsible for the selection, training, and development of staff.

To Qualify For This Position, You'll Need:

• Required Education: Bachelor's in a job related field

• Required Work Experience:

  • 7 years of claims processing experience including 6 years of system testing

  • 3 years of management/supervisory experience, OR 3 years of equivalent military experience in grade E4 or above (may be concurrent)

• Required Skills and Abilities:

  • Possesses excellent management, communication, analytical, and human relations skills

  • Proficient in provider reimbursement methodologies, budget planning, and monitoring

  • Strong in presentation, organization, customer service, negotiation, and computer systems support

  • Excels in organizational, analytical, and presentation skills

• Required Software and Tools:

  • Microsoft Office

  • Knowledge of FISS and MCS

What We Prefer You Have:

• Strong technical acumen

• Claims experience with Part A, Part B, and Home Health and Hospice is STRONGLY PREFERRED

• Workflow system knowledge

• Project Management Certification

• Leadership training skills

What We Can Do For You:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here'smore information.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.