• Manager, Claims Operations

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5428
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    The Claims Operations manager provides oversight of the claims adjustor staff and is responsible for establishing departmental policies and procedures and leading a high performing team. In this role, the manager is responsible for managing and overseeing the timeliness of claims payment and the accuracy of claims payment. In addition, the manager will oversee all tasks deemed as exceptions to the adjudication of the claim but may have direct impact on the organization. This position is a management position and is involved in developing strategy for ongoing and future claim operations and processes. The Claims Operations manager should have working knowledge of Medicaid, Medicare and Commercial health care programs and benefits.

     

    Responsibilities

    • Manages, supports and coaches direct reports enabling them to deliver exceptional quality work and meet their performance goals/objectives
    • Monitors efficiency and compliance with policies and provides coaching when needed
    • Monitors daily production to ensure that all claims adjudicated timely and accurately based on 14 day and 30 day claim payment requirements
    • Manages and facilitates all aspects of training for the Claims Department, which includes, but is not limited to: conducting training classes, managing external training, preparing training documentation and working in cooperation with other employees on training initiatives
    • Responsible for hiring, retaining and conducting employee evaluations
    • Provide strategic input into current and future claim department operations
    • Perform auditing of high-dollar claims or high-volume claims for appropriate payments
    • Identify trends and provide resolution to problems and issues pertaining to claims entry and/or payments
    • Handle difficult claim issues or phone calls as directed by staff or management
    • Makes informed decisions and solves problems using data analysis and critical thinking skills

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

     

    • Bachelor’s Degree Required, preferably in Business or Health Care Administration

     SPECIAL KNOWLEDGE AND/OR SKILLS

     

    • Excellent verbal and written communication skills
    • Adaptability and flexibility
    • Accountability and execution oriented
    • Organizational skills
    • Analytical and problem solving skills
    • Creativity and critical thinking skills
    • Quick and continuous learning style
    • Working knowledge of various software packages such as Microsoft Office (Excel, Word, Power Point)
    • Working knowledge of CPT-4 coding and ICD-9/ICD-10
    • Working knowledge of various medical claim types, including electronically filed claims, portal submitted claims and paper submitted claims processes
    • Ability to motivate staff in a production-based environment

      WORK BACKGROUND/EXPERIENCE

     

    • 3 years or more in a supervisory or leadership capacity
    • 5 years or more in claims processing experience or a combination of education and experience which would provide an equivalent background
    • Experience and demonstrated success in recognizing/developing talent and nurturing a team environment which results in open collaboration and strong business results
    • Experience in production based environment helpful
    • Preferred: Prior management of at least 15-20 direct reports
    • QNXT knowledge is a plus

     PHYSICAL REQUIREMENTS

    • Physical health sufficient to meet the ergonomic standards and demands of the position

     

    All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

     

    Our mission is to inspire healthy living within the communities we serve!

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