Branch Complex Director leading branch operations and teams of Financial Advisors at Wells Fargo Advisors. Focusing on organic growth and staff management in Florham Park, NJ and surrounding areas.
About the role
- Director of Claims Cost Management leading innovative strategies to optimize reimbursement and reduce medical spending. Collaborating across functional teams to enhance claims cost management initiatives.
Responsibilities
- Build and lead a comprehensive CCM strategy, leveraging internal tools and external vendors.
- Oversee programs for claim editing, coding validation, anomaly detection, and payment accuracy.
- Collaborate with network partners to ensure reimbursement integrity and address emerging billing trends.
- Integrate claims insights into prior authorization and early intervention strategies.
- Develop dashboards, cost-savings reports, predictive analyses, and financial impact assessments for leadership and Trustees.
- Identify inappropriate claim submissions and translate findings into actionable recommendations.
- Drive initiatives that improve billing accuracy, reduce rework, and promote high-value care.
- Lead cost-management pilots, system enhancements, and vendor-supported programs.
- Ensure compliance with national standards, audit expectations, and Fund policies.
- Manage CCM vendor relationships and performance in partnership with MCVA.
- Foster a culture of continuous improvement, accountability, and innovation.
Requirements
- 10+ years in claims operations, payment integrity, or cost management with measurable financial impact
- 5–7 years in leadership roles
- Claims adjudication
- Reimbursement methodologies
- Payment accuracy programs
- Bachelor’s degree or equivalent experience; coding certification preferred
- Strategic and financial acumen
- Data-driven decision-making
- Program/project management
- Advanced Excel and claims editing systems
- Developing and coordinating policies and procedures
Benefits
- Medical
- Dental
- Vision
- Paid Time-Off (PTO)
- Paid Holidays
- 401(k)
- Short- & Long-term Disability
- Pension
- Life
- AD&D
- Flexible Spending Accounts (healthcare & dependent care)
- Commuter Transit
- Tuition Assistance
- Employee Assistance Program (EAP)
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