Vice President - Customer Service & Claims

Blue Cross of Idaho Health Service is seeking a Vice President - Customer Service and Claims with a strong track record of exceptional work and extensive experience to join our mission driven organization. As a leading healthcare payer in the market, we are committed to delivering flawless service to our customers and collaborating with top employers across the state.

As the Vice President (VP) of Customer Service and Claims, you will have the unique opportunity to provide strategic direction, business planning, and overall executive leadership for customer service and claims operations across all customer segments within our organization. Reporting to the Chief Operations Officer, this executive role will be based at our corporate headquarters in Meridian, ID, USA. #LI-Onsite

Responsibilities:

• Provide leadership and coaching to the customer service and claims leadership teams, fostering a culture of accountability, professional development, learning, high-performance, and ethical behavior.

• Ensure fair, accurate, consistent, and timely processing of claims in compliance with member policies, provider contracts, and government regulations.

• Work closely with both leadership and front-line staff to discover areas for process improvements and efficiency enhancements, promoting a culture of continuous improvement within the department.

• Continuously review core processes and make improvements to increase efficiencies. Develop and define processes, workflows, methods, tools, training, and expected outcomes to support effective practices.

• Ensure all inquiries regarding claims status, benefits, and eligibility are answered accurately, timely, and with excellent customer service.

• Participate as a member of the executive staff to support effective corporate-wide operations.

• Enhance technology solutions to ensure accurate and timely processing of claims while improving auto-processing rates.

• Establish division objectives aligned with company goals and produce regular status reports.

• Prepare and manage the department's operating budget, controlling expenditures within approved budgets.

• Approve personnel actions such as hiring, disciplinary actions, termination, and salary recommendations.

• Promote teamwork, discussion, cooperation, and a respectful and diverse workplace.

• Develop and maintain departmental policies and procedures.

Requirements:

• Minimum of 10 years of progressive leadership experience in customer service and claims within healthcare insurance operations.

• Formal leadership experience leading multi-level teams.

• Healthcare operations experience.

• Experience in government programs, including Medicare, Medicaid, and Qualified Health Plans.

• Bachelor's Degree in business or healthcare administration or related field; or equivalent work experience.

• Master of Business Administration (MBA) or related field preferred.

• CMS Compliance experience preferred.

• Strong strategic problem-solving skills with a proven track record of exercising initiative, judgment, and discretion.

• Ability to translate data and metrics into measurable recommendations.

• Working knowledge of contact center and healthcare information systems.

• Ability to build relationships, collaborate, and motivate teams to achieve results.

• Proficient in effectively managing tasks with multiple opposing priorities.

• Excellent interpersonal verbal and written communication skills.

• Strong executive-level presentation skills.

• Advanced working knowledge of Microsoft Office suite.

Join our team and make a meaningful impact on the lives of Idahoans. Blue Cross of Idaho understands that your health and wellness matter, which is why we offer a comprehensive benefits package to support your well-being. We believe in investing in our employees' career development and provide tools and resources to help them grow professionally. Additionally, we encourage our employees to give back to their communities through volunteering and being active participants in community initiatives. We also provide reasonable accommodations to enable individuals with disabilities to perform the essential functions of the job.

If you are a customer-centric leader looking to join a dynamic organization dedicated to providing world-class service, apply now and become a part of our mission to build a brighter future for all of us.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.