Director of Operations

The Director of Operations will be accountable for the Claims, Claims Acquisition, Enrollment, and Member Advocate teams working with PBA’s leadership team to set the course for PBA’s future. Must be an outgoing business leader who can observe, analyze, and continually improve the operation to ensure it runs as efficiently as possible for PBA's success. This role reports to the COO/Integrator. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsibilities

• LMA (Lead, Manage and support a culture of Accountability) using the EOS model to continually develop future leaders.
• Developing, mentoring, and evaluating Operations staff including, but not limited to, annual reviews and Quarterly Conversations.
• Oversight and accountability of the entire Operations team which includes:
  • Member Advocacy (Customer Service)
  • Claims Acquisition
    • Claims Prep
    • PPO Liaison
    • Provider Maintenance
    • Mail Room
  • Enrollment
  • Claims
    • Claims Processing
    • Training/Auditing
    • Excess stop loss claims
    • Plan Loading
    • Medical Management navigation between PBA and UR Vendors
• Vendor management/documentation
• Strategic Planning: Develop and implement operational strategies that support overall business objectives.
• Process Improvement: Analyze and refine business processes, workflows, and policies to boost efficiency and performance.
• Financial Management: Manage operational budgets, control costs, and monitor financial performance metrics.
• Leadership & Supervision: Lead teams, set guidelines for staff, and foster cross-functional collaboration.
• Performance Monitoring: Track key performance indicators (KPIs), analyze data, and report on operational health to executives.
• Accountability: Holds departments accountable for goals, tracks metrics, ensures follow-through, and drives results.
• Resource Management: Oversee production, inventory, vendor relationships, and resource allocation.
• Reporting department activity to COO/Integrator on a weekly basis.
• Applying observations and feedback to continually improve PBA’s operation.
• Other duties as assigned.

Requirements for this position

• 7+ years managing, coaching, and directing larger teams in a similar service based or claims operation.
• 5+ years managing Third Party Administration Claims processing.
• Ability to travel for quarterly meetings and/or client engagements when necessary.
• Stoploss experience or knowledge a strong plus.
• Javelina claims system experience or knowledge a strong plus.
• Senior level organizational, analytical and accountability skills are necessary.
• Effective verbal and written communications.
• Demonstrated ability to get results through team members and management.
• Adaptability to new concepts and systems.
• Problem solver and critical thinker.
• Open minded with a desire to learn, grow and receive feedback in a welcoming way.
• Must be able to represent PBA’s Core Values and business procedures to vendors, brokers, and clients.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $175,000-$190,000 per year.

Member Advocate

The Member Advocate is responsible for providing excellent customer service to our members and providers. This position requires strong communication skills, problem solving, and overall client satisfaction. This individual reports to the Member Advocacy Manager. Please see below for a more in-depth overview of daily responsibilities and skills required for this position.

Responsible For

• 50+ incoming calls per day to provide quality customer service to callers.
• Developing and maintaining problem solving skills and troubleshooting abilities for the purpose of assisting callers and going the “extra mile” when necessary.
• Accurately identifying callers needs, conducting research and assisting with issue resolution.
• Provide clear communication with focus on empathy and professionalism.
• Referring to any claims or issues that require adjustments, processing, repricing, or other intervention according to guidelines.
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems.
• Own issues through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
• Responding to portals and all e-mails timely.
• Placing follow-up calls to members and providers, timely.
• Maintaining a working knowledge of plan benefits.
• Suggesting process improvement ideas.
• Presenting problems/trends to Management.
• Performing other duties as assigned to support PBA’s Mission, Vision and Core Values.

Skills Required for this Position

• 2+ years in a customer service-oriented role which required communicating over the phone.
• Maintain a positive work atmosphere by behaving and communicating in a manner so that you get along with customers, clients, co-workers, and management.
• TPA/Insurance Company environment or medical billing office experience preferred.
• Customer focused and adaptable to different personality types.
• Multitask with numerous customer service computer screens.
• Excellent typing skills, clearly documenting call notes.
• Active listener and provide empathy and understanding to callers.
• Strong verbal communication and interpersonal skills.
• Ability to quickly learn and adapt to new concepts/systems.
• Professional and responsible work ethic.
• Ability to interface with various levels of the organization.
• Proficient in Microsoft Office Suite products.

Essential Functions Statement

• The person in this position may work in the office up to 4 times per month, if local. The other days can be worked either in the office or remotely.
• In this position you must be able to exchange accurate information/communication with co-workers, customers and vendors.
• Demonstrate strong attention to detail.

Benefits and Compensation

• PBA offers a wide range of benefits including medical, dental, vision, life insurance, AD&D, critical illness, accidental illness, FSA, disability and 401k.
• The range for this role is $21-$24 per hour

Physical Demands

• This is largely a sedentary role which requires the ability to sit for long periods of time.
• The person in this position constantly operates a computer and other office machinery, such as a calculator, copy machine, and computer printer.
• To perform the physical requirements of the position, the employee must be able to: possess manual dexterity in his or her hands in order to keyboard; see; hear, talk, walk; sit; stand; report to work and stay at work for regularly scheduled work shifts and occasional overtime; communicate clearly, cooperatively, and professionally with co-workers, supervisors, clients, and outside vendors; and maintain professional relationships with co-workers, supervisors, clients, and outside vendors.