SVP, Claims Quality and Transformation (Finance)
The Senior Vice President (SVP) of Claims Quality and Transformation leads initiatives to elevate claims handling standards, compliance, client satisfaction, and operational efficiency. This role oversees strategic transformation projects, quality assurance, and client-focused service strategies. The SVP drives innovation through advanced technology, predictive modeling, and quality engineering to ensure the organization maintains its leadership in claims management excellence.• Bachelor's degree in Business, Risk Management, or a related field
• Advanced degree or relevant certifications (preferred).
• Minimum of 15 years in claims management, quality assurance, or related fields.
• Proven track record in leading large-scale transformation and compliance initiatives.
• Experience in managing complex claims, audits, and client service engagements.
• Industry certifications such as CPCU, AIC, or ARM (preferred).
• Willingness to travel for client meetings, audits, and compliance initiatives.
• Expertise in claims handling best practices, Medicare compliance, and statutory requirements.
• Proficiency in predictive modeling, quality review systems, and advanced reporting tools.
• Strategic thinking with the ability to implement innovative solutions.
• Strong leadership and project management capabilities.
• Excellent interpersonal and communication skills for client and team interactions.Claims Quality:
• Develop, implement, and maintain Claims Handling Best Practices.
• Modernize the Quality Review System and Best Practices, incorporating new tools and methodologies.
• Develop tools to improve claim quality audit results
• Develop claim closure tools and metrics
• Act as a Subject Matter Expert (SME) on jurisdictional nuances, technical strategies, and emerging trends.
• Manage the Claims Staffing Report to align workloads with budgetary and quality objectives.
Compliance:
• Partner with branches to enhance systems and align claims execution with regulatory requirements.
• Decrease Errors and Omission by implementing Best Practices within the claim offices
• Liaise with internal auditors, managing technical claim testing, results, and action plans.
Client Service:
• Build and maintain strategic relationships with clients, brokers, and carrier partners.
• Support business development and client retention efforts through consultative service approaches.
• Lead service strategy development to meet client-specific requirements and deliver measurable outcomes.
Strategic Transformation Initiatives:
• Drive innovation through advanced technology, AI, and quality engineering to optimize efficiency.
• Oversee metrics-driven reporting to track performance, trends, and improvement opportunities.
Reporting and Analytics:
• Develop and oversee daily claims reporting to ensure compliance with Best Practices and operational efficiency.
• Drive insights from claims metrics to improve processes and address challenges.
Efficiency Initiatives:
• Lead projects to evaluate and implement claim transformation strategies without compromising quality.
• Research and deploy emerging technologies to enhance operational efficiency.
Education:
• Bachelor's degree in Business, Risk Management, or a related field
• Advanced degree or relevant certifications (preferred).
Knowledge and Skills:
• Minimum of 15 years in claims management, quality assurance, or related fields.
• Proven track record in leading large-scale transformation and compliance initiatives.
• Experience in managing complex claims, audits, and client service engagements.
• Industry certifications such as CPCU, AIC, or ARM (preferred).
• Willingness to travel for client meetings, audits, and compliance initiatives.
• Expertise in claims handling best practices, Medicare compliance, and statutory requirements.
• Proficiency in predictive modeling, quality review systems, and advanced reporting tools.
• Strategic thinking with the ability to implement innovative solutions.
• Strong leadership and project management capabilities.
• Excellent interpersonal and communication skills for client and team interactions.
