Healthfirst

The Sr. Mgr., Claims Modernization, Operational Excellence is a thought leader and implementer on our approach to a unified and streamlined claims and provider payment process with the intent and purpose of delivering best-in-class service to our members and providers. He/she aligns Claims business processes with technology to ensure the successful operation and delivery of Healthfirst services for federal, state, and commercial programs. He/she ensures the efficient and compliant operational management of Claims with emphasis on execution, outcomes, continual improvement, and performance enhancement. This role is instrumental in ensuring overall adherence to regulatory expectations while improving the overall quality of work output. The role requires cross-functional work to ensure department and corporate strategies are executed and achieved enterprise-wide.

                In partnership with Claims Modernization leadership and key stakeholders achieve the following objectives…

• Develop and implement an Operational Excellence strategy for the entire Claims & Provider Payment Modernization effort, ensuring its long-term success
• Build and lead a team of Operational Excellence experts who can support the creation and delivery of Operational Excellence
• Map the Claims Modernization effort to the Capabilities, Business Areas, Processes, and Technologies impacted
• Establish Capability, People, Process, and Technology frameworks using the latest Operational Excellence methodologies
• Partner with the program team, the business, support functions, and key stakeholders to refine, deploy, and maintain frameworks
• Work with IT and Claims Modernization Reporting & Analytics to build the supporting infrastructure required to scale & sustain frameworks
• Use framework results to guide Claims Modernization and Performance Improvement activities, bridging the gap between current & future state as well as driving improvement in key program and business metrics
• Build and maintain strong relationships throughout the organization to ensure alignment with new solutions and ultimately to successfully gain end user adoption
• Demonstrate how an Operational Excellence program delivers value to the Claims & Provider Payment Modernization effort, as well as the larger enterprise

Minimum Qualifications:

• Bachelor’s degree from an accredited institution or equivalent work experience
• Minimum of 8-10 years of experience in operational excellence, process improvement, or a related field
• Strong leadership and team management skills, with the ability to influence at all levels of the organization
• Excellent problem-solving and analytical skills, with a data-driven approach to decision-making
• Project management experience, including the ability to manage multiple activities simultaneously
• Strong communication and presentation skills, with the ability to articulate complex ideas and influence key stakeholders

Preferred Qualifications:

• Master’s degree from an accredited institution in a relevant field
• Lean Six Sigma Black Belt or comparable certification
• Industry work experience in healthcare / health insurance
• Work experience leading / supporting a recognized best-in-class Operational Excellence program

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430

• All Other Locations (within approved locations): $102,600 - $156,655

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.