Director Financial Operations - Payment Integrity Operations

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Director Financial Operations is responsible for coordinating, directing, and managing key operational functions supporting Payment Integrity Operations. This Director provides leadership across operational, analytical, project, and technical areas, using data and business insights to drive operational and process excellence, improve workforce and inventory effectiveness, and support strategic priorities.

Serves as a key liaison between upstream and downstream business partners to ensure operational alignment, effective communication, and successful execution of cross-functional initiatives. Provides oversight of departmental initiatives, inventory management, and operational reporting, while partnering closely with Payment Integrity Strategy, Product, and Digital teams to align strategic priorities with operational capabilities, readiness, and execution. Leads and participates in cross-functional and enterprise-wide initiatives and serves as a key partner to business, technology, and senior leadership.

Primary duties may include, but are not limited to:

• Counsels senior management on enterprise-wide policies and strategies and provides operational insight regarding performance, risks, business impacts, remediation plans, and go-forward strategies.
• Represents the company in legal matters and testifies as needed.
• Develops and implements vision, strategies, and tactics to maximize the department's effectiveness while minimizing costs, with a focus on operational and process excellence, workforce and inventory management, and opportunities to improve workflows through data and technology.
• Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.
• Works with other areas to develop solutions to complex operational problems and participates in critical interactions with both internal and external customers. Partners across operations, data, technology, and other business areas to identify root causes, improve processes, and support enterprise initiatives.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports and provides leadership across multidisciplinary operational, analytical, project support, technical, automation, and quality functions.
• Serves as the primary operational liaison across upstream and downstream partners, collaborating with Payment Integrity Strategy, Product, and Digital teams to align strategic priorities with operational needs, identify dependencies, influence solutions, and support implementation readiness and end-to-end execution.
• Provides oversight of departmental initiatives, coordinating priorities, milestones, deliverables, risks, and cross-functional dependencies to drive accountable execution of operational, process, and technology improvements.
• Leads departmental inventory management and reporting, maintaining visibility into inventory health, workload, productivity, performance trends, and operational risks to inform leadership decisions, resource planning, and continuous improvement.
  

Requires minimum of 8 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes and a minimum of 5 years management experience; or any combination of education and experience which would provide an equivalent background.

• Payment Integrity experience with a strong understanding of claims operations, operational workflows, and the mechanics of Payment Integrity work, preferred.
• Strong data and analytical fluency, including experience using reporting, inventory analytics, and performance data to identify trends, diagnose operational issues, and support decision-making, preferred.    
• Operational and process excellence experience, including the ability to evaluate workflows, identify root causes, and determine whether opportunities are related to training, process, goals, or technology, preferred.
• Experience leading in a complex healthcare operations environment with demonstrated agility, responsiveness, sound judgment, and the ability to manage multiple competing priorities, preferred.
• Experience leading or partnering across multidisciplinary functions such as workforce management, project support, reporting and analytics, technology, automation, and quality, preferred.
• Strong executive-level written and verbal communication skills with experience translating operational performance, risks, remediation actions, and go-forward plans for senior leadership, preferred.      
• Experience across multiple healthcare lines of business, another health plan or Blue plan, or a Payment Integrity vendor environment, preferred.
• Experience supporting enterprise-level projects and/or managing operational vendor relationships, preferred.
• Knowledge and application of Lean Six Sigma or comparable continuous improvement principles, preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.