Sr Consult, Claims Resolution

About the role

This remote role within the PLADS division focuses on claims resolution and subrogation. You will collaborate with internal business partners to develop and monitor KPIs, lead projects and initiatives that impact business success, and work directly with leadership to identify and build out business improvement initiatives in support of strategic goals.

Principal Duties & Responsibilities

• Collaborates with internal business partners to develop and monitor KPIs for subrogation and other operational vendor serviced functions; develops and executes recommendations for continuous improvement initiatives.
• Monitors results, outcomes and trends with suppliers, and ensures timely and accurate reporting for compliance and regulation purposes.
• Leads the planning, organization and implementation of projects and initiatives that impact the success of the business including achieving financial outcomes and customer commitments.
• Creates specific reporting tools and methods to capture and track critical milestones and impacts to business goals.
• Works directly with leadership to identify and build out business improvement initiatives in support of strategic business goals.
• Monitors supplier costs, tracks payments and resolves payment and expense issues while optimizing cost.
• Consults with business leaders and end users to solve vendor issues, and adheres to governance frameworks for driving provider performance.
• Responsible for monitoring and maintaining budget, and identify areas for cost savings and process improvements
• Develop and implement measures to assess and manage risks, ensuring that appropriate mitigation strategies are in place.
• Responsible for delivery of all projects and work efforts aligned to supplier initiatives.
• Collaborates with operational stakeholders to identify business improvements and efficiency opportunities.
• Leads or participates on project teams or committees assisting with the development, planning, and implementation of strategic long-range and short-range goals and objectives.
• Establishes and maintains strong working relationships with business partners as the key point of contact.
• Works with leadership in tracking the progress made on departmental goals.
• Performs other duties as needed.

Requirements

• Bachelor's Degree in Management, Business Administration, Health Care Management or a related field.
• 6 or more years of professional job-related work experience.
• Strong understanding of claims processes and compliance.
• Or an equivalent combination of education and experience.
• Travel ≤ 10%

Skills

• Strong organizational skills to manage multiple subrogation and recovery opportunities.
• High attention to detail to ensure accuracy in documentation and reporting.
• Problem-solving skills to address obstacles.
• Strong communication and negotiation skills.
• A high degree of skill in the analysis and resolution of complex and sensitive scenarios.

Pay

$110,000 - $150,000

Benefits

• Medical, dental, and vision coverage
• Prescription drug coverage
• Health care flexible spending
• Dependent care flexible spending
• Aflac supplemental policies (Accident, Cancer, Critical Illness and Hospital Indemnity offered at no cost to employee)
• 401(k) plans
• Annual bonuses
• Opportunity to purchase company stock
• 11 paid holidays annually
• Up to 20 days PTO to be used for any reason
• State-mandated sick leave (where applicable)
• Adoption and parental leave

Schedule

Remote role within the continental US, with occasional in-office attendance as requested based on business need.