VP, Claims & Customer Care

Job Description

Title: VP, Claims & Customer Care Department: Operations Admin Support

Bargaining Unit: NBU Grade: N/A

Position Type: Exempt Hours per Week : 40

Position Summary

The VP, Claims & Customer Care provides oversight, leadership, and strategic direction to Claims and Customer Care operations to achieve and maintain service excellence in accordance with Company guidelines, client needs, financial parameters, and regulatory requirements.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."

Key Duties and Responsibilities

• Oversees all aspects of claims, customer service and eligibility/enrollment operations to ensure client and member needs and expectations are consistently met; proactively addresses issues, concerns, or additional operational needs.
• Develops and implements strategic and tactical plans to enhance claims handling, eligibility management, and customer service operations delivery to improve client retention and profitability.
• Plans, controls, and coordinates claims, customer service, and eligibility/enrollment activity and workflow to maintain the highest professional customer service and technical standards.
• Mentors, coaches, and trains leadership staff consistent with Company values and mission.
• Develops staff through performance management, goal setting, training, and effective employee relations to ensure superior service is consistently provided.
• Implements and monitors internal systems, policies, and procedures to ensure efficient and effective operations.
• Oversees quality and quantity of work produced to ensure compliance with regulatory requirements and consistent delivery of client requirements.
• Establishes key performance indicators with reporting on and analysis of operational metrics for claim, customer service, and eligibility/enrollment operations.
• Prepares and distributes reports to stakeholders.
• Partners with Client Services to resolve customer/client service issues and assists in the successful implementation of new clients and changes for current clients.
• Oversees the management of expenses and labor allocations for assigned location to ensure operations remain within budget parameters; determines and implements appropriate course correction when needed.
• Partners with Client Services to address and resolve service issues or escalations with clients; attends client meetings as needed.
• Partners with information technology, project management, legal, finance, and other departments or teams to ensure compliant, efficient, and accurate service to clients.
• Maintains communications and effective working relationships with management and staff, clients, government agencies, unions, participants, attorneys, and consultants.
• Keeps abreast of industry changes affecting claims, customer service and eligibility/enrollment
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor's degree in a business-related field and twelve years of experience working in claims and customer service operations leadership roles.

Or

• Associate's degree in business-related field and twelve years of experience working in claims and customer service operations leadership roles.
• Thorough knowledge of call center telephony, benefits, eligibility and claim adjudication principles, and reporting systems.
• Experience with call metrics and analysis, staffing models, workforce management, medical/dental terminology and ICD-10 and CPT-4 codes
• Experience in performance management according to call metrics. (KPI).
• Strong business acumen and a good understanding of business strategy in the insurance or related industry.
• Ability to effectively assess the long-term and short-term implications of decisions on the organization.
• Professional maturity with proven success nurturing internal and external relationships.
• Aptitude for creative, strategic thinking and experience executing process improvement measures.
• Exceptional team player with the confidence and integrity to earn client and internal team confidence quickly.
• Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities.
• Proven ability to recruit, lead and motivate a team to balance staffing strength with profitability and growth.
• Experience managing a successful remote workforce.
• Exceptional analytical and problem resolution skills; ability to exercise independent, sound judgment.
• Highly developed sense of integrity and commitment to customer satisfaction.
• Ability to communicate clearly and professionally, both verbally and in writing.
• Ability to effectively manage remote employees in diverse locations and regions.
• Computer proficiency including Microsoft Office applications and tools.

Preferred Qualifications

• Experience in a third-party administrator or health and welfare industry.
• Thorough understanding of Taft-Hartley environment.
• Master of Business Administration.

*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job. Duties, responsibilities and activities may change at any time with or without notice.

Working Conditions/Physical Effort

• Prolonged periods of sitting at a desk and working on a computer.
• Must be able to lift up to 15 pounds at times.

Disability Accommodation

Consistent with the Americans with Disabilities Act (ADA) and other applicable federal and state law, it is the policy of Zenith American Solutions to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Recruiting Department at recruiting@zenith-american.com, and we would be happy to assist you.

Zenith American Solutions

Real People. Real Solutions. National Reach. Local Expertise.

We are currently looking for a dedicated, energetic VP, Claims & Customer Care with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operates over 44 offices nationwide. The original entity of Zenith American has been in business since 1944. Our company was formed as the result of a merger between Zenith Administrators and American Benefit Plan Administrators in 2011. By combining resources, best practices and scale, the new organization is even stronger and better than before.

We believe the best way to realize our better systems for better service philosophy is to hire the best employees. We're always looking for talented individuals who share our dedication to high-quality work, exceptional service and mutual respect. If you're interested in working in an environment where people - employees and clients - really matter, consider bringing your talents to Zenith American!

We realize the importance a comprehensive benefits program to our employees and their families. As part of our total compensation package, we offer an array of benefits including health, vision, and dental coverage, a retirement savings 401(k) plan with company match, paid time off (PTO), great opportunities for growth, and much, much more!

Internals to Apply:

If you meet the minimum qualifications and are interested in applying for the above position, please submit an application. All applications must be received by 5:00 pm on the Internal Posting Deadline listed above in order to be considered prior

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