Director, Business Platform Performance

<strong>Working at Advantasure is more than a job &mdash; you&rsquo;re part of a team that is becoming the country&rsquo;s leading healthcare solutions provider.<br /></strong><br /><strong>A career at Advantasure means you&rsquo;ll be part of one of the most dynamic, diversified and innovative healthcare companies in the nation. You&rsquo;ll be helping our clients make their members healthier &mdash; and our communities a better place to call home.</strong>

United States, USA

Advantasure

<p class="p1"><strong>At Advantasure, we partner with healthcare clients to simplify their operations and accelerate their business success. Powered by our broad expertise and a comprehensive suite of product and service solutions, we help health plans effectively navigate the complexity of healthcare.</strong></p> https://advantasure.com/

keywords: develop,talent acquisition,culture,leadership,teamwork,environment,analysis,management,compliance,experience,education,skills,knowledge

Full Time

Competitive Compensation and Benefits Package

Overview: This role provides day-to-day leadership and oversight to a multi-department Medicare Advantage services organization. Responsible to achieve performance metrics, business goals, and objectives for assigned functions. Provides timely, accurate, and complete reports and status updates. Develops policies, procedures, controls and ensures compliance to and consistent application of regulations, contracts, policies, and procedures for all assigned areas. Motivates a diverse group of distributed individuals to work effectively as a high-performing team. Fosters a culture of accountability, inclusion, and operational excellence. Develops and implements continuous process improvements. Attracts, recruits, trains, develops, coaches, and retains top talent.<br /><br />Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws.&nbsp; Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.
Responsibilities: <ul> <li>Analyze the business requirements of assigned functions to assist in determining ongoing technology needs</li> <li>Identify the need for upgrades, configurations, or new systems and report to the COO</li> <li>Guide business and IT executives in making investment decisions that balance and prioritize current operational demands, service disruptions, and opportunities with the longer-term strategic vision</li> <li>Serve as a key member of the leadership team, handling tactical and strategic responsibilities</li> <li>Provide day-to-day leadership and oversight of assigned functional areas (e.g., UAT, Quality, etc.)</li> <li>Plan, develop, organize, implement, direct and evaluate the work of functions within the scope of responsibility</li> <li>Monitor operations regularly and systematically and report results to the executive team</li> <li>Drive accountability and authentic commitment to an inclusive environment in support of objectives</li> <li>Manage and cultivate relationships with clients, vendors, affiliates, and other key stakeholders</li> <li>Serve as a member of various leadership and advisory groups providing project guidance</li> <li>Creates an environment of continual improvement and adaptive innovation which is responsive to the needs of the team and the organization</li> <li>Stays current on regulatory requirements and company compliance policies, ensuring timely staff education.</li> <li>Participates in the development of the annual departmental budget, monitors budget, and identifies budget discrepancies.&nbsp; Researches cause and make recommendations.</li> <li>Responsible for balancing workload to optimize the effectiveness of the department</li> <li>Initiate and execute special projects as directed</li> </ul>
Requirements: <p><strong>EDUCATION:</strong></p> <ul> <li>Bachelor&rsquo;s Degree in business or related field required.</li> <li>Master&rsquo;s degree or equivalent preferred.</li> <li>A relevant combination of education and experience may be considered in lieu of a degree.&nbsp;</li> <li>Continuous learning, as defined by the Company&rsquo;s learning philosophy, is required</li> </ul> <br /> <p><strong>EXPERIENCE:</strong></p> <p>Ten years experience in a health plan, payer, or relevant environment with a demonstrated experience that provides the necessary knowledge, skills, and abilities.&nbsp; Five years of increasing leadership experience in health plan management or a BPO setting are required.&nbsp; &nbsp;<br /><br /><br /></p> <p><strong>SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED:</strong></p> <ul> <li>Leadership experience that reflects a proven track record of success.</li> <li>Recent and related health plan, BPO experience, client relationship management experience</li> <li>Deep technical understanding of payor platforms</li> <li>Extensive experience planning, analyzing and recommending technology projects that achieve business goals and objectives</li> <li>Experience with system design and development from business requirements analysis through to day to day management</li> <li>Demonstrated business platform experience with Claims, Enrollment, COB, Member/Provider Services, Configuration (benefit, pricing, provider), Appeals &amp; Grievance, Provider Data Management, Client Relationship Management, Vendor Management</li> <li>Ability to lead collaboratively across a matrixed organization in a fast paced, growth-oriented environment</li> <li>Substantial knowledge of health plan operations, insurance products, payer systems and processes</li> <li>Expertise with Medicare Advantage and government insurance programs</li> <li>Proven ability to build a culture of trust and respect with internal and external stakeholders.&nbsp;</li> <li>Excellent communication and relationship management skills.</li> <li>Demonstrated ability to conceptualize and develop new ideas and opportunities for improvements</li> <li>Proven ability to effectively manage distributed employee teams, both office-based and remote.</li> <li>Excellent communication and presentation skills.</li> <li>Track record of anticipating business and client needs and implement processes and products that support them</li> <li>Superior team building and leadership skills with the ability to motivate a diverse group of individuals to work effectively as a high performing team.&nbsp;</li> </ul>