Director II, Digital Claims Operations at Elevance Health

Atlanta, Georgia, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

BA/BS degree in Information Technology, Computer Science or related field of study
Minimum of 8 years experience leading technology (application development, configuration, maintenance or implementation and support) teams and/or cross functional project (technology and operations) teams; or any combination of education and experience which would provide an equivalent background
7 years' management experience

Responsibilities

Oversee a combined digital and operations unit(s); execute strategies to deliver industry leading digitized service results
Serve as a leader across departmental lines to further penetration of operational digitization, E2E efficiencies, lowered administrative costs and an excellent member and provider experience
Lead digital transformation initiatives that improve claims operations and overall service delivery
Partner with leaders across the organization to implement strategic plans and shared goals
Lead overall strategic work streams for transformational priorities which requires significant accountability and management of numerous special projects
Plan, direct, and control the resources and efforts within a blended Digital Claims Operations organization
Effectively manage the resolution of intra-organizational issues in the balanced best interests of the business
Execute objectives of the company and the blended Digital Ops organization
Be responsible & accountable for implementation / management of digitization initiatives that demonstrates understanding of current and future operational business processes that digitization does/can enable
Ensure compliance with state and federal regulations
Oversee strategic planning, budget development, and management for a single large or multiple cost centers, contract compliance, and any necessary integration of government regulatory requirements
Manage an enterprise suite of applications by developing digitization forecast and delivery plan
Ensure disaster recovery and business continuity plan are implemented, monitored, and updated on a recurring basis
Deliver operational guidance and offer system solutions that support the operations of their functional areas on a 24x7x365 basis
Plan and execute annual projects while maintaining profit and loss (P&L) responsibility
Develop a strong team through training and effective organizational development practices
Implement the policies, practices, and procedures of the company and blended digital and operations organizations
Manage direction of information system and programming activities of technical staff
Leveraging reporting and analytics tools, continually monitor procedures and operational metrics to ensure these are met by staff
Build strong partnerships with market and digital leads, Benefits Administration, Provider Engagement and Contracting, Sales and Internal Audit
Hire, train, coach, counsel, and evaluate performance of direct reports

Skills

Digital Transformation

Claims Operations

Strategic Planning

Project Management

Operations Management

Process Optimization

Stakeholder Management

Change Management

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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