Claims Operations Associate Director

100% Remote environment, hiring in the following U.S. states: CT, FL, GA, IL, IN, MA, MI, NC, NY, NJ, PA, VA, WI, OH, and TX.

At MCIC Vermont , we protect our subscribers and their healthcare providers with best-in-class insurance and cutting-edge risk intelligence to support their healthcare delivery, medical education, and clinical research needs. Since 1978, we have been providing medical professional and general liability insurance coverage and risk management services to our academic medical centers. With the help of our academic medical center subscribers, we create, implement, and monitor innovative programs that realize our strategic objectives to manage risk, improve patient safety, and promote cost savings. These programs provide valuable services and enable success for our subscribers and their healthcare providers.

The Claims Operations Associate Director is a subject matter expert responsible for providing regulatory operational support for MCIC’s internal and external customers. This includes ensuring compliance with internal controls, Medicare, and other mandated regulatory reporting. Collaborates with IT and functional areas to monitor and improve regulatory outcomes. Responsible for the efficient, timely, and accurate processing of new claim reporting in partnership with institutions. Contributes to MCIC enterprise-wide initiatives for Claims.

Job Overview (Duties/Responsibilities):

• Exhibits an understanding of the Claims business function as well as its strategy, vision, short-term and long-term goals, and operational responsibilities.
• Provide regulatory-focused operational support and related training for internal and external stakeholders.
• Exhibits leadership Influence to gain consensus among stakeholders.
• Identify and implement opportunities to streamline, improve, and/or automate internal regulatory and other processes for efficiency, compliance, and improved data quality.
• Delivers Medicare reporting compliance through accurate and timely data capture in partnership with the institutions, IT, and Legal.
• Partners with Data Analytics for timely and accurate state or federally mandated reporting as required, including oversight for National Provider Data Bank compliance.
• Responsible for initial efficient and timely processing of new claims, including capturing critical data and assessing initial coverage review.
• Contributes to the development of comprehensive documentation of regulatory procedures and other processes.
• Stays abreast of and elevates regulatory changes that impact the Claims business function.
• Partners with Finance to regularly review the accuracy of regulatory claim internal controls and execute reviews to ensure compliance.
• Participates in special projects, including data governance and integrity, enterprise-wide strategic initiatives, department reporting, and other projects as required. Leads data quality projects as requested.

Requirements

(Skills/Requirements for Hire):

• Bachelor’s Degree required.

• 6-8 or more years of operational and/or technical claims experience.
• Must have knowledge of Medicare reporting requirements.
• Must have Regulatory experience (ideally within insurance).
• Medical Professional Liability experience preferred.
• Project Management experience.
• Analytical, interpersonal and oral/written communication skills.
• The ability to foster a culture of collaboration and organizational excellence.
• Knowledge of legal and medical terminology, preferred.

Benefits

WHAT WE HAVE TO OFFER

• Competitive Salary: approx. $90,000-120,000/year, based on experience.
• Bonus Potential (up to 5%)
• Comprehensive Benefits Package (more details available during interview)
• Remote Work Environment (100% work from home)