Senior Director of Operations - PACE

Overview

Company Overview:

Advance Your Career in Insurance Claims with Allied Universal® Compliance and Investigation Services. Allied Universal® Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you’re ready to grow with the best, explore a career with us and make a difference.

Job Description

Allied Universal® is hiring a Senior Director of Operations - PACE. The Senior Director of Operations - PACE oversees a team that is responsible for all customer service functions and quality control of the final investigative SIU product. The Senior Director of Operations serves as the liaison between the client and the field staff who conduct the investigation.

RESPONSIBILITIES:

• Oversight of SIU (Special Investigative Unit) Investigations team associated with the PACE contract
• Use independent judgment to define and confirm client objectives (including due dates) on all new, reopen, and investigative referral cases
• Provide consultation to the client using independent discretion to develop and implement an efficient, effective, and ethical investigation of an insurance claim
• Ensure adherence to clear guidelines regarding company policies on privacy, compliance, and ethics
• Ensure independently that the investigators assigned to complete the investigative tasks requested by the client have been given clear instruction on the client’s expectations at the time the case is approved
• Maintain quality control after investigation is completed, ensuring that all client’s objectives have been addressed and achieved, and the billing applied to this work product falls within the standard billing schedule or client contract rates
• Ensure team meets “reopen” sales goals on a monthly basis, creating accurate funding records for all items billable to the client
• Use sound management, discretion, and independent judgment to resolve conflicts between clients and/or investigators
• Handle customer complaints (negotiating as needed) and forward field operational issues to appropriate Vice President as needed
• Provide daily updates to the clients within one business day after an investigative task has been completed, or per the client’s updating protocols set forth in a contract (if applicable)
• Timely document follow up communication to clients after the final work product has been delivered; this communication is to ensure client satisfaction and determine if any additional investigation is required
• Meet clients’ completion due dates and provides client recommendations on current cases for future work
• This individual must utilize discretion and independent judgment to resolve conflicts between clients and/or investigators.  Must routinely meet the established standards of performance and compliance for this position in the areas of generating revenue, minimizing CCBR (closed case budget remaining), and minimizing service reviews (credit memos), while ensuring superior customer service and a quality investigative product

QUALIFICATIONS (MUST HAVE):

• Must possess one of the following:
• Bachelor’s degree in Healthcare Administration, Nursing, or Business
• Associate’s degree in Healthcare Administration, Nursing, or Business and a minimum of eight (8) years of related experience in a healthcare leadership role
• Minimum of three (3) years managing or directing an SIU insurance investigation program
• Minimum of six (6) years of experience in a progressive healthcare leadership role
• Ability to think strategically, make timely decisions and implement change
• Ability to remain highly productive in a changing environment, possess strong attention to detail and well-developed organizational skills, and maintain a high level of discretion
• Demonstrated proficiency in using subscription databases to search for relevant information on investigative assignments in support of the technical and professional staff of the SIU
• Outstanding written and oral communication skills
• Proficiency in Microsoft Outlook, Excel, Word, and PowerPoint

PREFERRED QUALIFICATIONS (NICE TO HAVE):

• Broad, general understanding of financial implications of managerial decisions and impact to the organization
• Ability to represent the company in a professional manner at all times during employment; never compromising the company’s core values of integrity, morals, values, or code of ethics

BENEFITS:

• Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
• Seven paid holidays annually, sick days available where required by law
• Vacation time offered at an initial accrual rate of 3.08 hours biweekly for full time positions. Unused vacation is only paid out where required by law

Closing

Allied Universal® is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.

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