WPS Health Solutions Director Claims Operations in Hampton, Virginia

Job Summary

Our Claims Operations Director will oversee all processes required to meet Defense Health Agency (DHA) standards for new eastern region TRICARE contract, including employee activities, production, and budget for approximately 180-250 employees at multiple sites. This positions oversight includes all outside involvement with Primes, DHA, Department of Health and Human Services (DHHS), Internal Revenue Service (IRS), Judge Advocate General (JAG) offices, Office of Foreign Assets Control (OFAC), and WPS offsite.

Characteristics and Responsibilities

  • Provide support and direction for management staff responsible for Military and Veterans Health (MVH) Claims Resolution, Claims Support, TRICARE Provider Certification Unit (TPCU), TRICARE Encounter Data System (TEDS), Fee Profiles, and Third Party Liability (TPL) units.

  • Oversee government change orders and enhancement projects ensuring positive impact in all areas of responsibility.

  • Work with all levels of MVH internal Subject Matter Expert (SME) management and WPS corporate units for Mailroom, Imaging, and Electronic Data Interchange (EDI).

  • Allocate assigned resources to meet all standards for external and internal customers using most cost-effective measures for workflow and inventory while remaining in compliance for quality and quantity needs.

  • Lead and share management of exempt staff in meetings and follow-through on staff-assigned projects. Attend and present at monthly meetings, representing units for all internal and meetings with external partners.

  • Serve as Liaison to Primes for provider Network coordination and JAG offices, to represent WPS MVH in meetings and emails to ensure responses are timely for all time-zone conflicts.

  • Sponsor and/or participate as SME for any Project and Portfolio Management Office (PPMO) projects affecting direct areas of responsibilities. Involvement includes approving and seeking approvals as Operations from Prime to coordinate with WPS Information Technology (IT).

  • Support budget of approximately 180-250 hourly and management staff.

  • Work closely with other Director of Claim Operations that shares similar units for other TRICARE contracts to ensure consistency and assist as needed in contracts outside the new easter region TRICARE contract.

  • Participate as SME and/or team member for strategic project development as needed.

  • Write performance appraisals for direct reports and review those written by direct reports including setting goals for next review period.

  • Participate as SME or team member in writing proposal bids for Government Request for Proposals (RFP), leading a proposal team as needed.

Qualifications

Work Experience

Required

  • 7 or more years progressive insurance/healthcare industry experience, to include

  • 3 or more years of experience in a supervisory role

Education

Required

  • Bachelor’s degree Business Management, Insurance, or related field; OR equivalent post high school education and/or work-related experience

Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.QualificationsRequiredPreferredLicenses & CertificationsRequiredPreferred