Director - Payer Domain (15-29 yrs)

Director - Payer Domain

Key Responsibilities:

1. Strategic Guidance:

- Drive strategy for payer operations, focusing on claims, member engagement, provider relationships, and cost management.

- Implement innovative solutions using AI, automation, and analytics to optimize processes.

- Stay abreast of industry trends and regulatory updates (e.g., CMS, ACA) to align strategies.

2. Enablement of Technology:

- Collaborate with tech teams to deploy advanced platforms for claims adjudication, payment integrity, and member engagement.

- Utilize predictive analytics to enhance risk management and optimize value-based payment models.

- Ensure compliance and interoperability with standards like HIPAA, FHIR, and EDI.

3. Leadership:

- Build and lead high-performing, cross-functional teams, fostering collaboration and accountability.

- Champion a culture of innovation and continuous improvement while mentoring team members.

4. Collaboration Among Stakeholders:

- Partner with providers, employers, and regulatory agencies to strengthen relationships and drive service excellence.

- Align payer strategies with population health and care delivery initiatives.

5.Financial Supervision:

- Manage budgets to ensure cost-efficiency and ROI while identifying opportunities to reduce MLR and enhance revenue.

Qualifications:

- Bachelor's degree; advanced degree (MBA/MHA) preferred.

- 25+ years of healthcare payer experience.

- Expertise in claims management, value-based payments, and regulatory compliance (CMS, HIPAA).

- Proficiency with payer tech platforms, analytics, and CRM tools.

- Exceptional strategic, problem-solving, and executive communication skills.