Strategic VP, Claims & Payment Integrity Operations

Blue Cross of Idaho; Carmel (IN); On-site; USD 130,000 - 180,000; Full time

Job summary

Blue Cross of Idaho is seeking a Vice President for Claims & Payment Integrity Operations. This role involves strategic leadership across the organization, focusing on claims processing accuracy and payment integrity initiatives. The VP will collaborate with various departments to improve operational efficiency and ensure compliance with federal mandates.

Candidates should have extensive experience in health plan operations, particularly in payment integrity, and a proven track record of leadership in complex environments. A Bachelor's degree is required, with a Master's degree preferred.

Qualifications

• Minimum 10 years in health plan operations, 5 in senior leadership.
• Expertise in payment integrity including FWA detection methodologies.
• Knowledge of health plan lines such as Medicare Advantage.
• Track record in payment accuracy improvement through initiatives.

Responsibilities

• Direct claims intake and adjudication across various lines of business.
• Design and implement payment integrity strategies.
• Ensure compliance with CMS Medicare Advantage claims processing.
• Lead and develop high-performing team.

Skills

Payment integrity programs

Claims processing expertise

Analytical decision-making

Regulatory acumen

Leadership

Education

Bachelor’s degree in Business Administration or related field

Master’s degree (MBA, MHA, MPH)

Tools

TriZetto Facets

Job description

Blue Cross of Idaho is seeking a Vice President for Claims & Payment Integrity Operations. This role involves strategic leadership across the organization, focusing on claims processing accuracy and payment integrity initiatives. The VP will collaborate with various departments to improve operational efficiency and ensure compliance with federal mandates.

Candidates should have extensive experience in health plan operations, particularly in payment integrity, and a proven track record of leadership in complex environments. A Bachelor's degree is required, with a Master's degree preferred.