Description and Requirements The Sr. Mgr., Claims Modernization, Operational Excellence is a thought leader and implementer on our approach to a unified and streamlined claims and provider payment process with the intent and purpose of delivering best-in-class service to our members and providers. He/she aligns Claims business processes with technology to ensure the successful operation and delivery of Healthfirst services for federal, state, and commercial programs. He/she ensures the efficient and compliant operational management of Claims with emphasis on execution, outcomes, continual improvement, and performance enhancement. This role is instrumental in ensuring overall adherence to regulatory expectations while improving the overall quality of work output. The role requires cross-functional work to ensure department and corporate strategies are executed and achieved enterprise-wide.

                In partnership with Claims Modernization leadership and key stakeholders achieve the following objectives…

Develop and implement an Operational Excellence strategy for the entire Claims & Provider Payment Modernization effort, ensuring its long-term successBuild and lead a team of Operational Excellence experts who can support the creation and delivery of Operational ExcellenceMap the Claims Modernization effort to the Capabilities, Business Areas, Processes, and Technologies impactedEstablish Capability, People, Process, and Technology frameworks using the latest Operational Excellence methodologiesPartner with the program team, the business, support functions, and key stakeholders to refine, deploy, and maintain frameworksWork with IT and Claims Modernization Reporting & Analytics to build the supporting infrastructure required to scale & sustain frameworksUse framework results to guide Claims Modernization and Performance Improvement activities, bridging the gap between current & future state as well as driving improvement in key program and business metricsBuild and maintain strong relationships throughout the organization to ensure alignment with new solutions and ultimately to successfully gain end user adoptionDemonstrate how an Operational Excellence program delivers value to the Claims & Provider Payment Modernization effort, as well as the larger enterprise

Minimum Qualifications:

Bachelor’s degree from an accredited institution or equivalent work experienceMinimum of 8-10 years of experience in operational excellence, process improvement, or a related fieldStrong leadership and team management skills, with the ability to influence at all levels of the organizationExcellent problem-solving and analytical skills, with a data-driven approach to decision-makingProject management experience, including the ability to manage multiple activities simultaneouslyStrong communication and presentation skills, with the ability to articulate complex ideas and influence key stakeholders

Preferred Qualifications:

Master’s degree from an accredited institution in a relevant fieldLean Six Sigma Black Belt or comparable certificationIndustry work experience in healthcare / health insuranceWork experience leading / supporting a recognized best-in-class Operational Excellence program

Hiring Range*:

Greater New York City Area (NY, NJ, CT residents): $119,900 - $183,430

All Other Locations (within approved locations): $102,600 - $156,655

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.