SVP Operations, Sentara Health Plan
Overall accountability for managing multiple call centers, the performance of several on and offshore vendors, the Utilization Management Intake request process, and provider issue resolution.
Drive change and innovation in a call center environment and have an outside-in perspective (is customer/provider driven; understands external trends and technological innovations)
Accountable for Optima plan operations to include claims, enrollment, sales operations, business integration and call center operations. Must be creative and able to develop new product launches, and operating system design to support growth, retention and profitability of the health plan.
Responsible for accurate claims adjudication and payment processes.
Lead the development and implementation of another operating center to assist as a back up to Optima's VA and NC centers.
Provide leadership over performance/earnings improvement activities. Collaborates on policy and program development to achieve business results through effective operations and financial management.
Collaborate with various business unit leaders and key external partners.
Master's Level Degree
• Successful leadership and experience working towards continuous process improvement. Focused on staff development for current and future roles.
• Senior leadership experience managing across multi-site operations.
• Several years of senior level experience in successfully managing a busy call center.
• Senior level experience working with medical claims.
• Senior level operational experience with Commercial and Government programs
• Consistent record of accomplishments and the capability/flexibility to operate effectively leading change as well as effectively managing change.
• Adaptability and Flexibility: Must thrive well in a fast-paced environment.
• Strong Communication Skills: Transparency and an open communication style will be important. He/she must be accessible and deemed approachable by employees and various business unit leads.
None, unless noted in the “Other” section below
• Health Plan Operations - 10 years
• Executive - 5 years
• Management - 10 years