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GEHA Director, Claims Applications in Lee’s Summit, Missouri

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

The Director of Claims Applications will oversee the teams responsible for the day-to-day care and feeding of the suite of applications that support GEHA’s claims operations. This role will require a strong insurance background with a focus on understanding business needs and translating these needs into technology solutions. In addition, the individual will have previous experience managing multiple complex applications, business stakeholders, and working across department lines to achieve performance excellence within technology responsibilities.

The position will oversee the strategic planning and execution of GEHA’s Claims Applications, including our claims processing platform and our clinical editing system and all attached components, including the functionality derived within the platforms. The Director supports business plans, defines the strategic roadmap, facilitates the planning of contingencies, establishes metrics, and ensures that the delivery of all products & services to support ongoing operations across business lines.

As a member of the leadership team, the ability to understand, develop and align with business and technology strategies and goals, and communicate to senior technology, business leaders, and external vendors is an essential component of the role. This role requires a passion for influencing and inspiring teams in developing and maintain solutions that meet the GEHA’s needs.

SKILLS

Key Responsibilities:

  • Responsible for defining and implementing the Claims Application Roadmap & Strategy, ensuring key inputs from all business stakeholders are considered, and working within and outside of the Claims Applications team to achieve the outlined objectives

  • Serve as a subject matter expert on claims operations functions and work with the business to define the use cases for our applications, including but not limited to:

  • Core Claims Processing Software

  • Enrollment Toolkits

  • Configuration Management Utilities

  • Payment Automation Tools

  • Enterprise Workflow Capabilities

  • Standard and Custom Extensions

  • Security Management Modules

  • Claims Testing Applications

  • Clinical Editing Application

  • Proactively research and provide benefits & recommendations on new functionality available within the Claims Application ecosystem to business partners

  • Lead a diverse team responsible for the stability and evolution the Claims Application platforms, including Application Architecture, Business Analysis, System Configuration, Custom Development and Engineering

  • Provide leadership and direction to Managers and Solution Architects to effectively inspire and influence teams and partners in delivering technology enabled business solutions that meet business needs

  • Evolve current manual or heavily customized solutions to more streamlined, less time intensive solutions, ensuring we are leveraging as much out of the box functionality as possible

  • Partner with Enterprise Architecture, Infrastructure and Technology Operations to ensure availability, reliability, and scalability of applications within the purview of Claims Applications

  • Apply industry experience and best practices to design, develop, and implement application enhancements within the ecosystem

  • Ensure all components and changes to the technologies are documented and approved in a systematic manner, providing transparency across business and technology partners

  • Manage the Claims Applications budget and contracts

  • Build relationships with key vendor partners

Qualifications

  • Bachelor's degree required, Master’s degree preferred. Additional work experience may be substituted for degree

  • 10+ years (or more) of relevant experience in healthcare payer space, with emphasis on claims payment and application management responsibility

  • Requires 5+ years of progressive leadership experience along with diverse roles and increasing responsibilities across business and IT, with demonstrable skill to communicate effectively with delivery teams

  • Requires previous experience managing complex claims applications; previous experience with Cognizant’s Facets application and associated components preferred

  • Demonstrable experience working with business stakeholders to align objectives and deliver technology to support the articulated needs

  • Demonstrable experience of engaging executives and other stakeholders to support important business decisions

  • Strong analytical and problem-solving skills

  • Excellent written, verbal and interpersonal communication skills to successfully collaborate with team members across multiple divisions

  • Experienced in leading a department using a variety of project execution methodologies including but not limed to Waterfall and Agile

  • Requires a proven record of meeting commitments and achieving goals through the encouragement, guidance and influencing of others

  • Requires working knowledge of Microsoft Office applications

GEHA is an Equal Opportunity Employer. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. Our company's corporate headquarters is located in Lee's Summit near Douglas Rd and I-470 with a total of five locations in the Kansas City metropolitan area.

GEHA is a leader in health services for federal employees and related customers, serving our chosen markets with low-cost offerings and best-in-class customer care, sustained by a nimble and efficient organization.

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