director of claims

Naviguard

<div><div><b>Director of Product Management of Claims Pricing &ndash; Minnetonka, MN or Telecommute</b></div>
<div></div><div>Careers at UnitedHealth Group</div>
<div>We&rsquo;re creating opportunities in every corner of the health care marketplace to improve lives while we&rsquo;re building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life&rsquo;s best work.</div>
<div></div><div>As the Director of Product Management of claims pricing, you will be tasked with overseeing a product delivery of claims pricing and all other pricing methodology. You will work across multiple product lines for a holistic solution that manages out-of-network utilization and patient experience. You will be responsible for understanding the needs of the enterprise pricing strategy and partner with Analytics team and Provider strategy &amp; initiative teams, developing a supporting product roadmap and overseeing execution against the roadmap. Your overarching focus will be on managing the prioritization of research and development of pricing methodology and build scaled capability based on business needs and technical and regulatory constraints. This position requires a motivated self-starter who has the flexibility and versatility to pivot to adjust to evolving business needs. The Director of Capability Management reports to the Senior Director of Product.</div>
<div></div><div>Primary Responsibilities:</div>
<ul><li> Create and drive increment product and capability roadmap based on business strategy, a prioritization process, and key objectives.</li></ul>
<ul><li> Collaborate with Provider strategy and Analytics teams to ensure claims pricing strategy alignment.</li></ul>
<ul><li> Collaborate with other product team leaders to ensure seamless integration and function conflicts and redundancy</li></ul>
<ul><li> Own the overall execution against the product roadmap, managing scope, timelines and stakeholder expectations</li></ul>
<ul><li> Conduct financial and pricing modeling, analysis and reporting</li></ul>
<ul><li> Influence pricing strategies and pricing package configuration decisions using a data driven approach</li></ul>
<ul><li> Provide consultative advice on use of data as subject matter expert and interpret / summarize analytical findings</li></ul>
<ul><li> Lead the development of strategic initiatives aimed at reducing the total cost of care</li></ul>
<ul><li> Work collaboratively with cross-functional teams including product value creation, program management, technology, legal, and other internal teams to execute your roadmap</li></ul>
<ul><li> Establish and analyze key metrics to help make product decisions</li></ul>
<ul><li> As necessary, own development team priorities and supply them with use cases, business requirements, and personas that reflect constituent expectations and needs and best practices</li></ul>
<ul><li> Ensure legal and regulatory compliance</li></ul>
<div></div><div>Daily Practices:</div>
<ul><li> Ability to think strategically and execute methodically</li></ul>
<ul><li> Strong interpersonal, communication and management skills</li></ul>
<ul><li> Strong analytical, project management and problem-solving skills</li></ul>
<ul><li> Ability to think creatively and comfort being hands-on in a fast-paced, entrepreneurial environment</li></ul>
<ul><li> High attention to detail including ability to manage multiple, competing priorities simultaneously</li></ul>
<ul><li> Willingness to roll up your sleeves and do whatever is necessary; general manager / owner mentality</li></ul>
<div></div><div>Required Qualifications:</div>
<ul><li> Bachelor&rsquo;s degree required</li></ul>
<ul><li> 7+ years of experience with provider payment methodologies like DRG, CMS, Fair health etc.</li></ul>
<ul><li> 5+ years of experience with product or capability development through entire product lifecycle</li></ul>
<ul><li> 5+ years of experience working with complex claims data and deep understanding claims billing included knowledge of CPT, HCPCS, Rev codes and ICD 10 codes.</li></ul>
<ul><li> 3+ years using product development and agile principles</li></ul>
<div>Preferred Qualifications:</div>
<ul><li> MBA or equivalent</li></ul>
<ul><li> Experience managing technical teams</li></ul>
<ul><li> Experience in products or capabilities</li></ul>
<ul><li> Excellent verbal and written communication skills including MS</li></ul></div><div></div>

Director of Product Management of Claims Pricing

Nesma Infrastructure & Technology

<div>
 <p>
  <strong>
   Job Purpose
  </strong>
 </p>
 <p>
  To support the implementation of NIT&rsquo;s Contract and Claims Management strategy by leading the preparation, administration, and monitoring of main contract and subcontract agreements.
 </p>
 <p>
  The role ensures proper contractual governance, timely claims and variations submission, and effective protection of NIT&rsquo;s contractual and financial entitlements.
 </p>
 <p>
  The Contracts &amp; Claims Lead provides expert advice to project teams, supports dispute avoidance, and ensures compliance with the company&rsquo;s contractual procedures.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Responsibilities
  </strong>
 </p>
 <p>
  <strong>
   1. Strategic / Departmental Support
  </strong>
 </p>
 <ul>
  <li>
   Support the development and implementation of CCD policies, procedures, and best practices.
  </li>
  <li>
   Promote strong contractual awareness and claims culture across project teams.
  </li>
  <li>
   Provide feedback to management regarding process improvements and recurring contractual issues.
  </li>
  <li>
   Contribute to the preparation and delivery of internal CCD training sessions.
  </li>
 </ul>
 <p>
  <strong>
   2. Contract &amp; Claims Leadership
  </strong>
 </p>
 <ul>
  <li>
   Lead the preparation, review, and administration of main contract and subcontract documents.
  </li>
  <li>
   Review and advise on contractual correspondence, amendments, variations, and claim submissions.
  </li>
  <li>
   Conduct contract/claims risk assessments during tender and project execution stages.
  </li>
  <li>
   Prepare reports, contractual analyses, and recommendations for senior management.
  </li>
  <li>
   Lead the collection, preparation, and submission of claims, extensions of time, and variations.
  </li>
  <li>
   Coordinate with project teams to ensure that obligations, notices, and timelines are strictly followed.
  </li>
  <li>
   Support the closeout of projects, including contractual compliance and final account settlement.
  </li>
 </ul>
 <p>
  <strong>
   3. Project-Level Support
  </strong>
 </p>
 <ul>
  <li>
   Advise project teams on contractual rights, obligations, risks, and opportunities.
  </li>
  <li>
   Review and comment on project logs and reports, including:
  </li>
  <li>
   Contractual correspondence logs
  </li>
  <li>
   Variation logs
  </li>
  <li>
   Claims logs
  </li>
  <li>
   Subcontract status logs
  </li>
  <li>
   Participate in project meetings and site visits to support contractual and claims-related matters.
  </li>
  <li>
   Coordinate with relevant departments to ensure accurate documentation supporting claims or variations.
  </li>
 </ul>
 <p>
  <strong>
   4. Staff Support &amp; Collaboration
  </strong>
 </p>
 <ul>
  <li>
   Provide technical guidance and mentoring to junior CCD staff when assigned.
  </li>
  <li>
   Assist in reviewing their work outputs to ensure consistency and accuracy.
  </li>
  <li>
   Participate in department meetings and contribute to continuous improvement initiatives.
  </li>
 </ul>
 <p>
  <strong>
   Required Skills and Qualifications
  </strong>
 </p>
 <p>
  <strong>
   Functional Skills and Knowledge
  </strong>
 </p>
 <p>
  <strong>
   Profession
  </strong>
 </p>
 <ul>
  <li>
   Bachelor's degree in Law or Civil Engineering.
  </li>
  <li>
   Postgraduate qualification in Construction Law preferred.
  </li>
 </ul>
 <p>
  <strong>
   Certification
  </strong>
 </p>
 <ul>
  <li>
   MRICS, MCIOB, or membership of a recognized engineering/claims institute desirable but not mandatory.
  </li>
 </ul>
 <p>
  <strong>
   Experience
  </strong>
 </p>
 <ul>
  <li>
   Minimum 8
   <strong>
    &ndash;15 years total experience
   </strong>
   in contracts and claims within construction/infrastructure.
  </li>
  <li>
   Minimum
   <strong>
    3&ndash;5 years
   </strong>
   in a senior/lead role handling complex contractual and claims matters.
  </li>
 </ul>
 <p>
 </p>
</div>


Contracts and claims lead

USAA

<p><b>Why USAA?</b></p><p>At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the choice for the military community and their families.</p><p>Embrace a fulfilling career at USAA, where our core values - honesty, integrity, loyalty and service - define how we treat each other and our members. Be part of what truly makes us special and impactful.</p><p><b>The Opportunity</b></p><p>Accountable for auto, property or other claims teams to deliver operational business results at scale. Responsible for member service, paying what we owe, controlling expenses, employee engagement, quality, operational risk and compliance across multiple MSTs. Executes and influences claim's strategies and plans. Leads diverse groups of virtual and office based teams across multiple geographic locations. Responsible for identifying and advancing broad process improvements to the operation including efficiency, effectiveness, compliance and regulatory adherence.</p><p>We offer a flexible work environment that requires an individual to be <b>in the office 4 days per week.</b> This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO or Chesapeake, VA.</p><ul><li>Influences, drives and supports operations strategy, plan, goals and objectives in support of Claims Strategy.</li><li>Accountable for supporting claims servicing solutions across process, technology, workforce, third party, and/or analytics in support of P&C product competitiveness</li><li>Provides directional guidance and workload prioritization duties in support of operations for the functional area assigned.</li><li>Establishes and maintains operational controls around member contact and non-member contact staffing requirements within assigned process.</li><li>Provides guidance on technical matters and extends settlement authority within their process (or as delegated).</li><li>Monitors the utilization, quality and costs of independent appraiser, adjusters, alliance partners and others in accordance with established quality, service and budgetary guidance.</li><li>Effectively leverages internal partnership to achieve shared accountabilities. </li><li>Responsible for leadership, communication, employee engagement and coordination of business and Enterprise initiatives. </li><li>Inspires a high performing team to deliver exceptional experiences to the members, engaged employees and achieve exceptional results.</li><li>Hires, develops, and coaches claims leaders for results delivery. </li><li>Creates conditions for success removes obstacles, leads and champions change.</li><li>Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.</li></ul>What you have:<ul><li>Bachelor's degree; OR 4 years of related experience (in addition to the minimum years of experience required) may be substituted in lieu of degree.</li><li>10 years of progressive customer service, operational, military or leadership experience to include minimum of 6 years demonstrated P&C proficiency and experience. </li><li>4 years of people leadership experience in building, managing and/or developing high-performing teams.</li><li>Demonstrated ability to lead through change, drive business results and create a culture of accountability.</li><li>Proven leadership and ability to influence at all levels of management.</li><li>Demonstrated ability to effectively communicate, both orally and in writing, to executive leadership, driving accountability and sense of urgency.</li><li>Strong knowledge and applied compliance with Department of Insurance, Fair Claims Practices and Federal regulations governing claims handling. </li><li>Business and technical acumen in the areas of effective claims handling processes, claims risk and compliance, integrated change management and front-line communications leading to operational excellence.</li></ul>What sets you apart:<ul><li>5 years Injury Claims adjudication experience</li><li>Minimum of 5 years of Operational experience leading teams who handle Injury and Casualty claims.</li><li>Bodily Injury management experience overseeing a distributed office and/or remote workforce.</li><li>Business analytics experience and/or experience working with data and metrics to manage the work and drive results.</li><li>Experience collaborating with key resources and stakeholders, influencing decisions, and managing work to achieve strategic goals required.</li><li>Executive-level business acumen in the areas of business operations, industry practices and emerging trends required.</li></ul>What we offer:Compensation:<p>The salary range for this position is: $169,880 - $305,780.</p><p><b> Compensation: </b> USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. </p><p> </p><p> Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. </p><p> </p><p> The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. </p><p> Long Term Incentive Plan: Cash payment for Executive level roles only, representing a cash payment which is both time and performance based. </p><p> </p><p><b> Benefits: </b> At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals. </p><p> </p><p> For more details on our outstanding benefits, visit our benefits page on </p><p> Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting. </p><p> </p><p> USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. </p>

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