Claims Compliance & Technology Director

At EMC, we’re all about working together to make an impact. As part of our team, you’ll have the opportunity to grow, contribute, and gain experience that matters. We strive to be caring leaders, close partners, and responsive experts—always supporting each other to do our best work. Join us, and let’s improve lives together.

**This position is eligible to work from home anywhere in the United States**

Essential Functions:

• Leads the claims compliance and Medicare compliance team across all lines of business and programs.  
• Provides oversight, guidance, and assistance to the team.
• Creates, tracks, and monitors KPI’s and creates a business plan for areas of oversight.
• Exports metric reports to monitor trends and track all team functions.  Implements standards and ensures workflow processes are consistently followed, and workloads are appropriately distributed among teams to create efficiency in resource usage and handling of duties.
• Monitors work product(s) for completeness, accuracy, turn-around time, and identifies trends and recommends and facilitates changes to improve efficiency.
• Implements the strategic direction and ensures the success of the claims training team across all lines of business and programs.
• Leads the prioritization and decision-making process as it relates to training activities to ensure implemented processes are effectively communicated to teams, meet organizational goals and are done so within financial and resource constraints.
• Ensures all testing and training is completed by appropriate teams, including technical team members, to validate updates and improvements function as appropriate.
• Establishes and enhances department-level best practices, ensuring department efficiency and consistency, and proactively provides feedback and communicates necessary changes.  
• Provides oversight, guidance, and assistance to the team.
• Creates, tracks, and monitors KPI’s and creates a business plan for areas of oversight.
• Exports metric reports to monitor trends and track all team functions.  
• Establishes and maintains claims onboarding materials for new hires to help ensure their success.
• Leads the claims information team across all lines of business and programs.
• Leads and directs the development for Guidewire transition and claims innovation and processes to support claims teams and ensures compliance within EMC Claims.  
• Implements the vision and strategy for the team by collaborating with Claims
• Leadership, stakeholders and subject matter experts to ensure goals and user experience outcomes are met.  
• Serves as the Guidewire subject matter expert on behalf of Claims to ensure system functionality, issues, improvements, and updates are built out correctly.
• Leads the team in creating and delivering pre- and post-implementation readiness activities.  
• Provides oversight, guidance, and assistance to the team.
• Provides direction on updating ClaimSite and offers guidance on internal claims communications surrounding procedures, forms, and guides.  
• Creates, tracks, and monitors KPI’s and creates a business plan for areas of oversight.
• Exports metric reports to monitor trends and track all team functions.
• Builds culture and develops team members while overseeing the team. Collaborates with team members to establish performance goals and monitors status, conducts performance reviews, and provides coaching.
• Addresses disciplinary issues, reviews progress and results, establishes action plans to bring issues to appropriate resolution.
• Develops team expertise and completes succession planning, including identifying talent and implementing development plans for critical positions. Supports diversity, equity, inclusion, and belonging initiatives.
• Fosters an innovative culture, including seeking and supporting new ideas and providing guidance on potential changes.
• Fosters an environment of collaboration with IT, Underwriting and other stakeholders.  
• Manages budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility.
• Utilizes Adaptive for tracking budget.
• Collaborates with claims teams from all lines of business regarding assigned claims teams to ensure efficiency and continuity across all of claims. Proactively communicates recommendations to Claims Leadership for improvement needed to meet company goals and to improve claim results. Participates in corporate-level claims projects and provides expertise on those projects with areas of oversight.
• Completes research and testing for projects.
• Provides updates to people leader on project status.

Education & Experience:

• Bachelor’s degree, preferably in insurance, finance, accounting, business administration or related field or equivalent relevant experience 
• Ten years of experience in claims, including experience in claims adjusting and claims compliance or related experience  
• Prior training experience preferred
• Insurance industry certifications, such as CPCU, INS or AIC preferred
• Guidewire experience preferred

Knowledge, Skills & Abilities:

• Excellent knowledge of insurance policies and claims philosophy, theory, practice of the claim function, procedures, and terminology, including knowledge of all lines of business EMC operates within
• Excellent knowledge of insurance contracts
• Excellent knowledge of claims data reporting
• Excellent in research, analytics, investigations and problem-solving
• Good knowledge of medical terminology preferred
• Excellent computer skills of applicable software and claims systems including Microsoft Office Suite
• Excellent Workforce Management skills
• Superior communication and interpersonal skills
• Superior organizational and written communication skills 
• Ability to work effectively in a team as well as independently
• Ability to manage multiple priorities and changing deadlines
• Excellent leadership qualities
• Occasional travel: a valid driver’s license with an acceptable motor vehicle report per company standards required if driving
   

The hiring salary range for this position will vary based on geographic location, falling within either the $109,818-$157,391 range or the $121,061-$173,534 range. A hiring range represents a subset of the full salary range.  The actual salary will depend on several factors, including relevant education, skills, and experience of an applicant, geographic location, and business needs. 

Our employment practices are in accordance with the laws that prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.

All of our locations are tobacco free including in company vehicles.