Claims Operations Management, Director ( Remote for TX residents only )
A$ A' A' ?Claims Operations Management, Director
Summary:
Under the direction of the Vice President, Claims Administration, this position is responsible for directing all claims administration for the company.
Directly supervises and is responsible for departmental staff and claim operations.
This position may be worked REMOTE in Texas only and preferably within a 90 mile radius of our Frisco, TX office.
There will be times that travel to the office will be required.
Qualifications:
Bachelor's Degree in Accounting, Business, Healthcare Management or a related field5
years of insurance or healthcare experience with billing and/or claims operations management experience5
years direct staff management required including hiring, training, assigning work and managing performanceExperience managing mid to large scale projects for improving processes or implementing new systems for billing and other related business processesExperience with management of application system vendorsExperience with dental claims is preferredAdvanced proficiency with computerized applications (Word, Access, Excel) and claims processing systemsExcellent communication skills (written and oral) and strong organizational skillsStrong customer service orientationWhat you'll be doing:
Under the direction of the Vice President, Claims Administration:
Functional Lead of new system implementation that has just recently beganDirect and oversee the operations of all claims administration functions to consistently meet the company's operational and financial requirementsPrepare departmental objectives, goals, workforce plans, and budgetsProvide direction, supervision and support to all claims staff including the assistant director of claims administration and all claims' processors in each divisionResponsible for retaining valued staff and replacing or hiring critical staff when applicableDevelop staff capabilities to ensure coverage, cross-training and development through continuous evaluation and feedbackOversee claim determination, payment, complaints and appeals processesEnsure prompt payment of all claims and timely responses to member, provider and client inquires and appeals according to state, federal and contractual requirements.
Develop and maintain departmental policies and standard operating proceduresEnsure staff and cross-functional teams are informed and trained on changes in policies and operating proceduresDevelop inter-departmental reports and dashboards to routinely track metrics, identify trends and/or issues and to ensure all claims department tasks are performed with accuracy and timelinessReduce errors and provide prompt issue resolution to prevent member, provider and client abrasion.
Disseminate data reporting from various sources to management on a regular basis with attention to detail and accuracy including timelinessMonitor reporting and escalate issues to Vice President, Claims Administration and senior leadership as requiredPlan, develop and implement projects, processes and technology to improve and manage all claims administration operations and all related processes to continuously improve and manage its cycles and increase profitabilityServe as functional lead for Claims department initiativesAct as a key driver for change to support organizational growth initiativesManage and direct the systems and processes for efficient and accurate claim reporting, billing and processingResponsible for working with IT leadership and staff on process improvement and optimizing the use of technology to automateCollaborate with other functional area leads including Member Services, Provider Relations, Operations, Account Management and IT to enhance cross-functional processes, to provide timely responses to issues, requests and complaints, and to implement new or revised in-house claims systemsCollaborate with cross-functional leads, including Sales, to recruit and onboard new clients.
Prepare monthly, quarterly and/or annual reports for clientsResponsible for pulling, analyzing and correlating data from a variety of software applications and reportsPrepare written comments as neededKeep abreast of client cost and advise other departments appropriately.
Estimated Salary: $20 to $28 per hour based on qualifications.
Summary:
Under the direction of the Vice President, Claims Administration, this position is responsible for directing all claims administration for the company.
Directly supervises and is responsible for departmental staff and claim operations.
This position may be worked REMOTE in Texas only and preferably within a 90 mile radius of our Frisco, TX office.
There will be times that travel to the office will be required.
Qualifications:
Bachelor's Degree in Accounting, Business, Healthcare Management or a related field5
years of insurance or healthcare experience with billing and/or claims operations management experience5
years direct staff management required including hiring, training, assigning work and managing performanceExperience managing mid to large scale projects for improving processes or implementing new systems for billing and other related business processesExperience with management of application system vendorsExperience with dental claims is preferredAdvanced proficiency with computerized applications (Word, Access, Excel) and claims processing systemsExcellent communication skills (written and oral) and strong organizational skillsStrong customer service orientationWhat you'll be doing:
Under the direction of the Vice President, Claims Administration:
Functional Lead of new system implementation that has just recently beganDirect and oversee the operations of all claims administration functions to consistently meet the company's operational and financial requirementsPrepare departmental objectives, goals, workforce plans, and budgetsProvide direction, supervision and support to all claims staff including the assistant director of claims administration and all claims' processors in each divisionResponsible for retaining valued staff and replacing or hiring critical staff when applicableDevelop staff capabilities to ensure coverage, cross-training and development through continuous evaluation and feedbackOversee claim determination, payment, complaints and appeals processesEnsure prompt payment of all claims and timely responses to member, provider and client inquires and appeals according to state, federal and contractual requirements.
Develop and maintain departmental policies and standard operating proceduresEnsure staff and cross-functional teams are informed and trained on changes in policies and operating proceduresDevelop inter-departmental reports and dashboards to routinely track metrics, identify trends and/or issues and to ensure all claims department tasks are performed with accuracy and timelinessReduce errors and provide prompt issue resolution to prevent member, provider and client abrasion.
Disseminate data reporting from various sources to management on a regular basis with attention to detail and accuracy including timelinessMonitor reporting and escalate issues to Vice President, Claims Administration and senior leadership as requiredPlan, develop and implement projects, processes and technology to improve and manage all claims administration operations and all related processes to continuously improve and manage its cycles and increase profitabilityServe as functional lead for Claims department initiativesAct as a key driver for change to support organizational growth initiativesManage and direct the systems and processes for efficient and accurate claim reporting, billing and processingResponsible for working with IT leadership and staff on process improvement and optimizing the use of technology to automateCollaborate with other functional area leads including Member Services, Provider Relations, Operations, Account Management and IT to enhance cross-functional processes, to provide timely responses to issues, requests and complaints, and to implement new or revised in-house claims systemsCollaborate with cross-functional leads, including Sales, to recruit and onboard new clients.
Prepare monthly, quarterly and/or annual reports for clientsResponsible for pulling, analyzing and correlating data from a variety of software applications and reportsPrepare written comments as neededKeep abreast of client cost and advise other departments appropriately.
Estimated Salary: $20 to $28 per hour based on qualifications.
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