Director of Claims Operations

Job Title: Director of Claim Operations

Location: Remote/Minimal Travel Required (< 5%)

US Citizen: Must be US Citizen

Security Clearance: Not Required

Apprio is an innovator of specialized technology and program solutions for the federal health, defense, and homeland security markets. The company provides services in technology transformation, organizational excellence, health IT & solutions, emergency response management, and international development. Apprio delivers the methodologies, discipline and expertise provided by the large integrators, with the cost structure and collaboration offered by smaller firms. Year after year we've grown by 50% or more due to our holistic approach in delivering solutions, thought leadership, and synergistic teams to address our client's needs.

Job Description:

Apprio is seeking a Director of Claim Operations. The qualified candidate will be co-leader/responsible for the daily operational activities associated with federal medical claims adjudication contract and the requirements of the contract Statement of Wok. Includes providing oversight of claims management and adjudication process and associated staff. Ensures and improves the performance, productivity, efficiency, and profitability of departmental operations through the provision of effective methods and strategies.

Responsibilities:

• In cooperation with the senior program leaders, serves as a primary customer liaison. Will collaborate regularly with customer identified staff to include government support teams and subcontractors
• Provides planning inputs for organizational, technical, and operational program management. Responsible for reviewing and providing data used in forecasts, operational improvements, budget management and assisting with tracking technical and financial performance.
• Works closely with customer(s) and team to ensure open and regular communication, both written and oral. Assist with development, implementation, and manage project schedules and budgets to meet contractual requirements
• Leads and mentors program staff.
• Identifies new capabilities and contract opportunities to present to leadership to grow business and leverages existing customer relationships to identify new customers that need current and new capabilities.
• Partners with the senior program leaders to provide leadership and ensure that all corporate policies and procedures are being followed.
• In cooperation with senior program leaders, act as a primary customer liaison representing and acting on behalf of Apprio and the program team.
• Supports the planning, organizing, completing, and presenting of performance metrics associated with program/project.
• Supports the evaluation of implications/risks on existing or proposed modifications to program/project.
• Routinely audit claims to ensure staff and technology tools are evaluating claims based on customer's contracts and Medicare coding guidelines.
• Act as subject matter expert for disputes regarding claim payment recommendations. Work with customer's staff to ensure they can accurately affirm the recommendation made for payment to the medical contractor.

Educational Requirement: Bachelor's Degree

Required Experience: 7 -10 years of experience

Required Knowledge:

Medical Claim Administration

Preferred Knowledge:

Third Party Claim Administration

Apprio offers a collegial and supportive environment focused on its greatest assets...its people. With a competitive compensation and benefits program designed to attract, motivate, and develop our people; we pride ourselves on creating a culture of teamwork, client focus, and fun. Our benefits program allows our employees to select the features that make the most sense for their individual and/or dependent(s) needs. Features include medical, prescription drug, dental, vision, disability, retirement savings, and a competitive paid time off program. Apprio is an equal employment opportunity company. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability or protected veteran status.

Privacy & Fraud Notice:
Apprio is committed to protecting the privacy and security of all job applicants. Please be aware of fraudulent recruiting activity that may attempt to impersonate Apprio or its employees. Apprio will never request payment, personal financial details, or conduct interviews via text or social media. All official communications come from an @apprio.com email address or within the career site of the job posting. If you suspect fraudulent activity, please contact https://apprio.com/contact-us/