Health Insurance Operations Director jobs in South Dakota

Award Winning Health Care: Avera has been named among the nation’s 15 Top Health Systems, Forbes list of America’s Best-in-State Employers and Level 10 Most Wired Health Care Organization by CHIME.

Culture: Be part of a multidisciplinary team built on teamwork, with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

You Belong at Avera: Advance Avera to the next level through innovation, side by side with a leadership team proven to help shape the future of health care.

Avera is currently seeking a highly motivated Director of Risk Management and Insurance Programs.

Position Highlights:

• More than a career! Avera is a mission-driven organization focused on people and our communities.
• As Director of Rick Management and Insurance Programs, manage and operate Avera's self-insurance and commercial insurance programs, excluding health insurance programs.
• Positive and productive team environment.

Job Summary

• Develops, implements, and integrates property, liability and workers’ compensation self-insurance and commercial insurance with attendant programs, policies, and activities. Develops, implements, and integrates new proactive insurance product programs, policies, and activities. Develops, integrates, and enhances Programs and Risk Management timely communication structures.
• Manages all technical, clerical, and related activities of insurance programs and claims administration which encompasses the development of techniques for forecasting potential and probable losses, cash flow analysis and actuarial loss data and trends, periodic reporting of claims administration, investigation of incidents and effectively managing incidents, settlement of claims, incident or variance report, trending, self-insurance fund activities, and preparing an inventory of all risks which are currently insured together with current insurance coverages. Such management responsibilities shall include the spectrum of potential risk from property to professional liability, such report to be suitable for preparing insurance specifications and obtaining commercial insurance bid quotations. Claims administration shall include working directly with patients, families, counsel, facility personnel and administrators as necessary to investigate, determine liability and causation and establish and carryout a course of action to resolve the loss.
• Conducts education and hands-on workshops that address and identify clinical and human issues, safety, outreach services, and related program activities on all current and future Risk Management issues.
• Develops and nurtures close working relationships with the Avera Insurance Committee, Avera Facilities administration, technical support personnel, System Peer Review and other management and supervisory personnel and further function as a liaison between the CLO & GC and such individuals.
• Presents practical solutions for common insurance, risk, and quality management concerns at new provider orientation, to provider and administrative leaders and to Avera Facilities.
• Makes regular field visits and education/outreach tours of Avera Facilities.
• Examines further areas of policy and program drafting, development and education as directed or requested by the CLO & GC.
• Maintains understanding of current trends in healthcare law, insurance products, underwriting requirements, and claims management fields, and is knowledgeable in the areas of professional and general liability, property loss, negotiation and settlement strategies, finance, business, and communications.
• Coordinates, in conjunction with the various commercial insurance companies utilized by Avera Health, the defense and/or resolution of Professional Liability, General Liability, Property, Worker's Compensation and other types of claims and lawsuits as necessary.
• Coordinates with the Office of General Counsel, the commercial insurance and self-insurance program for Avera Facilities.

Education and/or Experience

• Bachelor’s Degree (Master’s Degree preferred) in Health Administration, Business Administration or related field required.
• Candidates with clinical training, an insurance background, a Master’s Degree, claims administration experience of five or more years or relevant experience are preferred.