Director Workers Compensation Service Operations

It's a great time to put the strength of First Health, a subsidiary of Coventry Health Care, Inc. behind your career. We are a progressive Fortune 500 company and a leader in managed health care.

 



We offer an experienced, self-motivated Director - Workers Compensation Service Operations a unique career opportunity in our West Sacramento, Ca location.

 



General Summary:

Responsible for managing Workers' Compensation operations (Product Management, Client Liaison, Front End, etc) across several sites to meet or exceed customer requirements and business objectives.

 

Essential Duties:

1. Serves as operational lead with Clients representing all product lines: Bill

Review, PPO, Front End, FROI, PPO. Maintains lead role with large/key clients

such as AIG, Liberty, Gallagher Bassett to manage operational demands. Develops

strategic, operational and tactical business plans to achieve desired goals.

2. Serves as lead on the operational implementation of new Workers Compensation

Products. Manages the resources across CSO and IT lines to ensure timely and

effective product/service rollout. Requires interaction with and knowledge of

EDI, PPO Pricing, Rates Management, Network/Data Management, FROI, Production

Support, MPN''s/HCN's/MCO's, and Bill Review.

3. Evaluates Workers Compensation Product offering for financial viability,

evaluates product position in the market place and develops strategies to ensure

and enhance competitive position in the market place.

4. Serves in lead role to coordinate new client implementations from an

operational perspective across all products with support from the

Implementations Team. Plans and manages resource utilization/requirements with

Directors for each product line.

5. Provides client onsite support to the Sales Team as needed to offer

assistance with new sales and up selling opportunities. Ensures client

expectations are within operational abilities from a delivery and service

perspective.

 

Job Requirements:

Bachelor's degree or equivalent experience. Significant experience (usually 7-9 years) in managed care or workers' compensation operations with management responsibility. Demonstrated leadership and motivation skills. Ability to initiate and drive change; demonstrated results-driven approach. Demonstrated process and project management ability. Ability to create, design, and communicate overall strategies for servicing internal and external customers. Strong influencing, negotiation and analytical skills.

 

Position may be filled in San Diego, Irvine, CA, Sacramento, CA, Houston, TX, or San Antonio, TX, Salt Lake City, UT

 



Excellent compensation and benefits package! Please apply to Director Ops Support Req # 12661 online

via the Career Center located on our Website: www.firsthealth.com . EOE, M/F/D/