Senior Director of Operations - PACE

Job Description

The Senior Director of Operations - PACE oversees a team responsible for all customer service functions and quality control of the final investigative SIU product. This role serves as the liaison between the client and the field staff conducting the investigation.

• Oversight of SIU Investigations team associated with the PACE contract
• Use independent judgment to define and confirm client objectives (including due dates) on all new, reopen, and investigative referral cases
• Provide consultation to the client using independent discretion to develop and implement an efficient, effective, and ethical investigation of an insurance claim
• Ensure adherence to clear guidelines regarding company policies on privacy, compliance, and ethics
• Independently ensure the investigators assigned to complete the investigative tasks requested by the client have been given clear instruction on the client’s expectations at the time the case is approved
• Maintain quality control after investigation is completed, ensuring that all client’s objectives have been addressed and achieved, and the billing applied to this work product falls within the standard billing schedule or client contract rates
• Meet “reopen” sales goals on a monthly basis, creating accurate funding records for all items billable to the client
• Utilize sound management, discretion, and independent judgment to resolve conflicts between clients and/or investigators
• Handle customer complaints (negotiating as needed) and forward field operational issues to appropriate Vice President as needed
• Provide daily updates to the clients within one business day after an investigative task has been completed, or per the client’s updating protocols set forth in a contract (if applicable)
• Timely document follow up communication to clients after the final work product has been delivered; this communication is to ensure client satisfaction and determine if any additional investigation is required
• Meet clients’ completion due dates and provides client recommendations on current cases for future work

Qualifications

• Must possess one of the following:
• Bachelor’s degree in Healthcare Administration, Nursing, or Business
• Associate’s degree in Healthcare Administration, Nursing, or Business and a minimum of eight (8) years of related experience in a healthcare leadership role
• Minimum of three (3) years managing or directing an SIU insurance investigation program
• Minimum of six (6) years of experience in a progressive healthcare leadership role
• Ability to think strategically, make timely decisions and implement change
• Strong attention to detail and well-developed organizational skills
• Demonstrated proficiency in using subscription databases to search for relevant information on investigative assignments in support of the technical and professional staff of the SIU
• Outstanding written and oral communication skills
• Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint

Benefits

• Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
• Seven paid holidays annually, sick days available where required by law
• Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law