Evolent Health Services is looking for a dynamic and strategic Senior Director level Domain Technical Lead, Claims. This role will report directly to the VP of Evolent’s Domain Technical team and provide the vital link between business and technical functions to ensure our claim operation strategy is infused into the entire solution lifecycle, from requirements gathering through design, testing, deployment and adoption. The claim domain consists of several key areas of EHS operations (Claims, Configuration, Provider Data Management, Payment Integrity, Authorizations and Encounters). As a Claims Domain Technical lead, this individual will consult on end to end operational and technical process solutions as part of implementation delivery and product strategy.
What You’ll Be Doing:
- Serve as key consultative point of contact between business and technology teams, facilitating and advising on strategic solutions focused on operational efficiency and cost containment.
- Transform visionary thinking into aligned action at all levels of the organization, with a focus on sustainable and cost-effective innovation while maintaining excellence in operations.
- Effectively partner with implementation delivery teams and play advisory role related to partner implementation delivery and optimization.
- Identify technical solutions and improvements for existing processes, develop business requirements and cases to promote those solutions and improvements, and work with the product team to deliver those requirements and solutions.
- Internally, build consensus, a sense of urgency and commitment to driving results. Act as a change agent within the organization.
- Evaluate new systems, potential vendor partners, and models to help to improve performance and efficacy of Evolent Health Services.
- Foster an environment that stimulates open communication, creativity, imagination and engenders a team spirit in solving problems and identifying and capturing new solution and business strategies.
- Contribute to maintaining a strategic product roadmap to ensure appropriate measures are used to prioritize technical/systems projects based on client requirements, quality improvement, regulatory requirements, and potential ROI.
- Collaborate with clients and external vendors effectively to optimize current and future solutions to achieve or maintain efficiencies.
- Perform other duties and projects as assigned.
- Play a key role in improving client experience, as well as continue to execute on Evolent Health Services strategy.
- Strengthen dynamics and be a conduit of continuous communication between domain technical team, business operational leadership, and product teams.
- Identify and facilitate solutions to improve areas of the business where operational overhead and efficiency require optimization.
- Lead improvements with implementation delivery modeling and execution.
- Create and drive the adoption of innovative strategy that pushes the status quo and are anchored in corporate values.
The Experience You’ll Need (Required):
- Bachelor’s Degree in Business Management/Administration, IT, healthcare related discipline or business-related discipline
- 10+ years of progressive experience within managed care organization, third-party administrator, or other healthcare entity
- 5+ years’ experience at a management level position
- Ability to easily manage and be flexible to fluctuations in demand of work and growth; effectively manage by reporting and strategizing on resource needs.
- Strong communication skills (both written and oral)
- Strong analytical and organizational skills
- Ability to work collaboratively across partner/organizations
- An innovative thought leader who consistently contributes new ideas that will improve and enhance the success of the organization and will challenge conventional thinking.
- Outstanding communication and organizational skills necessary to present powerful conceptual frameworks in combination with compelling and supporting analytical facts necessary to introduce new initiatives.
- A high-energy individual who is disciplined and focused, and yet viewed by colleagues and subordinates as a very positive, genuine personality. Someone who is clearly focused on doing what is in the best interest of the enterprise.
- Hands-on professional who is a natural leader, adviser, consultant and strategist with the demeanor, business maturity, intellect and integrity required to establish immediate credibility.
- High impact, low ego professional who thrives in a team setting, motivated by the mission of the larger organization.