VP Health Plan Operations - Claims
Cambia Health Solutions

Job Info

---

VP Health Plan Operations - Claims

Oregon, Washington, Idaho, Utah

Cambia Health Solutions is committed to simplifying the member journey. We are looking for a leader with experience in healthcare operations, specifically with claims payments.

The Vice President of Health Plan Operations - Claims provides the strategic leadership vision, direction and cross functional execution of operations department (example: Business Planning/Claims/Customer Service/Group Administration) functions. Identifies strategies and aligns them with the changing business environment. This role effectively uses data analytics, best practices, world class operations transactions and outside the box thinking to strengthen member and provider satisfaction. This role requires extensive collaboration with internal teams throughout the organization including Healthcare Services, Sales, Product and Network Management.

General Functions and Outcomes

• Actively participates as key member of Operations Leadership Team to improve quality, manage costs, and enhance service to members. Drives strategies and necessary change within the department, across the organization, and with vendor partners.
• Provides leadership in developing, implementing, and communicating short and long-range plans, goals, and objectives for the function. Aligns team goals with the organization's vision and strategy. Manages the organization to ensure results are achieved across functions and various Lines of Business.
• Determines appropriate staffing levels and resource needs, creates and manages department and/or project budgets, allocates resources, and approves expenditures.
• Makes recommendations as to the use and selection of external vendors. Ensures there is appropriate operational leadership and oversight to vendors. Identifies cost effective technologies, workflows and sourcing partnerships necessary to meet strategic commitments.
• Fosters an effective work environment and drives a culture of innovation and engagement. Participates in organizational talent management and succession planning.
• Delivers executive-level consulting and operations design regarding how plans effectively manage process interactions with Regence and our members.
• Leads business planning and execution for the designated business area.
• Ensure continuous improvement in reducing the cost and complexity of transactions and increasing service levels and response times.
• Integration of Operations across the health plan with an emphasis on improved efficiencies and cross-functional communication and collaboration.
• Strengthening effectiveness through fast and accurate processing and reducing operating costs to benefit members.
• Effectively support cost stewardship initiatives to deliver affordable healthcare to members.

Minimum Requirements

• Proven business acumen including strong financial/budget management, data analysis and decision making.
• Ability to create, execute and evaluate short- and long-term strategic and operational plans.
• Strong influence, communication and problem-solving skills along with the ability to resolve issues and build consensus among groups of diverse stakeholders, both within and outside the organization. Ability to raise awareness of performance gaps and secure support from leaders across the organization to launch needed improvements.
• Demonstrated ability to lead high performing teams and to organize and support cross functional activities to deliver results in a complex, matrix organizational structure.
• Demonstrated ability to provide oversight and understanding of business process redesign and to drive change in order to improve clinical and business outcomes.
• Proven ability to apply broad knowledge and innovative problem solving to create competitive business plans that improve quality and lower cost.
• Demonstrates a well-founded understanding of the insurance industry.
• Demonstrated thorough knowledge of various systems in support of operations functions.

The VP Health Plan Operations - Claims would have a bachelor's degree in business management, healthcare administration or related field and 12 years of experience in management with at least 3 years in a Health Insurance operations or production environment or equivalent combination of education and experience.

FTEs Supervised

5-10 direct, up to 400 indirect (approx.).

.

The base pay annual salary range for this job is $215,500 - $350,500.

In addition, this role has a robust incentive plan based on organizational goal achievement.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

• medical, dental, and vision coverage for employees and their eligible family members
  
• annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  
• paid time off and company holidays
  
• up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  
• up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  
• one-time furniture and equipment allowance for employees working from home
  
• up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.
  

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.

This job has expired.