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.
An Executive Order was released stating that federal contractors must require COVID-19 vaccinations for all US employees. As a company that works on federal contracts, we have a legal requirement to comply with the executive order, if it is enforced.
The Vice President - Operations is responsible for strategic leadership and the execution of the vision & roadmap for GEHA’s claims processing, Appeals, Enrollment and other health plan operations.
The Vice President - Operations is responsible for the development and execution of claim operations strategies, end-to-end claim process automation, optimization, and management, identifying and leveraging technology and data to improve the quality, minimize process cost of claims, and support a positive experience for our GEHA members.
The Vice President - Operations will provide strategic leadership and development of the Claims, Appeal, Enrollment and Business Operations departments and its employees, as well as collaborate with Network Development, Provider Affiliation and Member Relations, Contracting, and Benefits Administration to ensure data integrity and to drive financial and operational value across GEHA health plans to maximize benefit coverage while containing cost.
The Vice President – Operations will leverage industry best practices, technology innovations and process redesign elements as part of the strategic vision to support the continued evolution of member engagement and satisfaction.Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.
The annual base salary range for this position is $194,712 - $292,067 USD.
Responsibilities include but are not limited to:
- Oversee the design, development, and implementation of GEHA’s a Claims Operations roadmap and strategy.
- Develop recommendations to align and support GEHA’s business strategy and goals.
- Develop positive, collaborative, and constructive cross-functional partnerships to drive change and influence individuals at all levels of the organization.
- Manages and directs the systems and processes for efficient and accurate claims reporting, billing and processing. Responsible for working with CIO and other IT staff on process improvement and optimizing the use of technology to automate.
- Recruit and develop strong talent that continuously looks for ways to improve end-to-end claims processing, services and operations by identifying best practices and driving process and program efficiencies.
- Deliver a differentiated high quality service experience in an efficient manner across a high volume, high transaction operation to ensure all Service Level Agreements are met or exceeded.
- Leverage data and identify trends to ensure expectations are met and provide regular updates on performance trends and activities.
- Create and deliver presentations for senior leadership on relevant call center and member satisfaction topics; prepare relevant content for Board presentations.
- Effectively manage vendor relationships and fully leverage their capabilities to support improved delivery of member services in a cost effective manner.
- Develop budgets and priorities, ensuring plans and resource allocations are managed appropriately within budget.
- Requires Bachelor's degree or combination of post high school education and related experience required.
- Requires 15+ years of health plan operation experience in a health care or insurance industry with preference for health plan experience.
- 8 or more years of leadership experience
- Demonstrated experience and relevant expertise in leading a large scale production operation. Prior Claims experience preferred.
- Demonstrated track record of driving organizational and operational changes in the day-to-day business of a high-volume operation using current and new technology.
- Strong data analytic skills with emphasis on driving continuous process improvement.
- Executive presence and demonstrated ability to influence, build trust and develop effective collaborative partnerships.
- Demonstrated ability to lead large complex enterprise projects and programs to successful completion, including building productive, cross-functional relationships and aligned objectives.
- Ability to communicate (verbally and in writing) effectively with senior leadership, managers, employees, and vendors.
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.