Your Role
The Payment Integrity & Corporate Recovery team is responsible for ensuring healthcare claims are paid accurately, both in a pre-pay and post-pay context.
It encompasses determining the correct party, membership eligibility, contractual adherence, and fraud, waste and abuse detection and prevention.
This team is responsible for over $M+ of cost of healthcare savings and avoidance annually and is also responsible for developing new capabilities to improve cost of healthcare exposure and performance, managing multiple third-party partners in pursuit and prevention of over-payments.
The Director of Payment Integrity & Corporate Recoveries will report to the Senior Director, Encounters Performance & Payment Integrity.
In this role you will build strong relationships with multiple functions within the overall Blue Shield organization, reduce cost of healthcare risks, and ensure accurate payments resulting in improved cost of healthcare and premium cost outcomes.
Your Work
In this role, you will :
- Leverage data and operational expertise to set a vision and lead strategies to optimize processes resulting in increased cost of healthcare savings, quality, and administrative cost optimization
- Influence relationships and partner with all levels of leadership up to and including the Chief Operating Officer and Chief Financial Officer
- Lead a team of dedicated subject matter experts, while providing learning and growth opportunities
- Hands-on engagement in evaluation, design, development, and implementation of new products that will improve Blue Shield’s payment integrity performance
- Identify novel avenues of pursuit for the improvement of payment accuracy
- Manage multiple vendor relationships across multiple disciplines and influence efficiencies resulting in cost savings and increased effectiveness
- Build and execute strategies and business cases as necessary to realize critical opportunities
- Build and develop a high performing team measured by key performance indicator results
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