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Diversity is a core value at Arcus that is embedded in every aspect of our culture and in the way that we conduct business. We are committed to fostering a diverse and inclusive environment, because we believe that when talented people with different perspectives and backgrounds come together, we can more effectively tackle the challenges of innovation, reinvention and maintain our competitive edge.

We demand the best

(We really do). Clients expect us to build a world-class professional team. Our goal is to assemble a group of the most qualified and talented individuals we can find and inspire them to peak performance. How do we do it? By associating with only top candidates and giving them the tools, training and work assignments to succeed.

We view each job opening as an opportunity to recruit the most talented, motivated candidates who go the extra mile. We look for the best and are committed to providing exceptional talent and total confidence.

Position Description

Director of COB/TPL

Our client is a not-for-profit organization headquartered in Newark, is the state's largest health insurer. There goal is the same as it has been since 1932 – to provide individuals and employers in New Jersey with convenient access to quality health care, wherever they live or work.

Our client is looking for a Director of COB/TPL for a permanent placement.  This individual creates a centralized Coordination of Benefits (COB)/Third Party Liability (TPL) Department.  Candidate will effectively direct the COB Governance, COB Operations (including but not limited to: Claims Processing and Member Management), and Third Party Liability Units (including but not limited to: Subrogation, Workers’ Compensation, Auto/No-Fault) of a large, high-profile department with multiple product lines to meet regulatory requirements, organizational, operational and customer needs and applicable goals.  This also includes acting as a liaison with Discovery and Recovery under Shared Services. 
Major Responsibilities

1. Leads the development of a centralized Coordination of Benefits (COB)/Third Party Liability (TPL) Department.
2. Initiate recoupment activities and work with Discovery & Recovery to address specific concerns and aid in reducing instances where inaccurate billings are occurring
3. Provide guidance to claims operations on calculation methodologies, coordinate the expansion and improvement of other insurance identification, investigate and identify members who potentially have other insurance coverage in order to properly coordinate claim payments.
4. Responsible for day-to-day management of COB data, reporting, metrics and analytics.
5. Serves as a lead subject matter expert on all COB/TPL matters with officers, directors, and outside agencies such as DOBI.
6. Accountable for all COB related activities including but not limited to:  implementing a uniform focus on COB, ensuring a consistent application and administration of COB throughout the Enterprise, ensuring accurate, consistent and timely reporting of COB information, ensuring that COB claims are processed timely and accurately, ensuring the proper internal administrative and accounting controls are in place, establishes and maintains the completeness and integrity of the COB member data.
7. Integrates TPL activities for Subrogation, Workers’ Compensation and Auto/No-Fault into the COB capability.
8. Presents to the Service Operations Leadership Team, Service Division Leadership Team, DOBI, clients and other parties/in other forums the status and results of activities and any major areas of concern/corrective action plans.
9. Develops the Strategy, Business Plan and Goals in accordance with corporate and divisional strategy and plans.
10. Responsible for achieving targets for: COB savings, TPL savings, COB and TPL cost avoidance and other goals specific to these operations.
11. Fosters an environment of continuous idea generation, learning and knowledge sharing.
12. Direct all COB Governance, COB Operations and TPL departmental operations to ensure timely, consistent achievement of prescribed goals including but not limited to; departmental performance targets, divisional quality & production standards, key enterprise priorities, Service Level Agreements (SLAs) and Performance Guarantees (PGs).
13. Continually identifies and pursues new, unique claims overpayment hypotheses to achieve savings targets.
14. Serves as the business owner for COB systemic initiatives
15. Serves as the business owner for development of the single source of truth of COB information.
16. Integrates COB and TPL Discovery and Recovery activities with the Service Division’s shared service Discovery and Recovery team.
17. Leverage knowledge, experience, data and tools to forecast, prepare for and respond to changes in inventory and/or greater business need/climate.
18. Champion process/ workflow improvements within or across departments/divisions
19. Develop/influence successful partnerships, interfaces and communications with key enterprise departments to drive goal achievement.
20. Capitalize on existing technology, optimizing system capabilities.  Identify and elevate opportunities to incorporate new technology into processes and workflows (especially manual processes and interventions).
21. Lead high profile internal and/or external workgroups, presenting findings to appropriate leadership teams.
22. Plans and maintains annual budgets. Seeks opportunities to maximize impact of spending.
23. Directs staff to ensure overall client satisfaction and appropriate level of service delivery.
24. Develops and monitors goals for staff and provides ongoing feedback and coaching.
25. Conducts performance reviews on an annual basis and administers salaries for the staff.
26. Directs the employment activities of the office that include staffing, development, and training. 
27. Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies, and procedures.

Candidate must have:

1. Requires a Bachelor's degree from an accredited college or university, preferably in Business Administration, Health Care Administration or Computer Science. 
2. Prefers a Masters degree. 
3. Insurance claim management experience required for a period of at least five (5) years.
4. Minimum of nine (9) years management experience required.
5. Preferred experience managing COB for a minimum of three (3) years.
6. Successful track record managing very large staff groups (200+ FTEs) preferred.
7. Knowledge of health insurance products required, experience directing multiple product line operations preferred.
8. Experience managing in a fast paced, high volume, transaction-driven environment necessary.
9. Requires strong knowledge of insurance payer practices, preferably in managed care business Requires extensive knowledge of insurance payer claims systems.
10. Requires extensive knowledge of NJ State and CMS COB Regulations.
11. Requires an understanding of data management.
12. Requires an understanding of system interfaces and extracts.

Nice to have:

1. Ability to manage multiple, dynamic work assignments and priorities, as well as diverse work/product teams.
2. Ability to communicate successfully with all levels of management, including those at the highest level of the organization.
3. Proven project management skills.
4. Strong leadership, strategic problem solving, analytical and interpersonal skills.
5. Exceptional written and verbal communication skills.
6. Strong analytical skills
7. Strong interpersonal skills

TO APPLY:
Please e-mail your resume to susan.stone@arcus.net . Thank you for your interest in our ad!

ABOUT ARCUS:
Exceptional Talent. Total Confidence.® That’s our message and we’re sticking to it. At Arcus, we're talent finders. We strive to keep businesses and organizations at the top of their game by providing excellence in technology staffing, recruiting and consulting.

We are looking for professionals who share our entrepreneurial spirit and are looking to land an outstanding position with a company who has consistently been recognized on the national level for their work in the staffing industry. We work tirelessly to build solid relationships with well-recognized organizations across the nation to learn about projects and opportunities.  And, because we spend so much time getting to know each candidate and their skill set, we are able to represent them with a level of unmatched confidence.