- Understand, define, and influence functional, usability, reliability, performance, and support requirements of claims end-to-end adjudication processes including claim intake, pre-adjudication, adjudication, post-adjudication, and payment process
- Develop and execute implementation plans, including timelines, budgets, and resource allocation
- Manage risk and ensure implementation activities are completed on time and within budget
- Provide the link between the technical and business views of the system by ensuring the technical solutions being developed meet the needs of the business
- Partner with business, architecture, and infrastructure and oversee all service levels to ensure business area satisfaction
- Lead and manage the implementation of new lines of business within the Claims organization
- Proactively work with stakeholders to identify future system opportunities and enhancements
- Track progress and provide regular updates to stakeholders
- Organize work teams, drive consensus, and ensure end-to-end policy/process integrity to accomplish project work, including: identification and confirmation of participants; establishment of a project plan; consistent work team engagement and productivity; meeting facilitation; consensus building; recommendation documentation, and implementation oversight
- Perform detailed analysis of data, workflows, policies, procedures, organization of staff, skills and offer potential solutions to execute initiatives
- Partner with operational leadership teams to resolve complex technology, data, and process-based issues, gaps, and risks
- Oversee the analysis of business processes and development of functional requirements and appropriately document and communicate captured information for validation and re-usability
- Identify and resolve issues that arise during implementation
- Stay up to date on industry best practices and regulations
- Contribute to the development and improvement of claims processes
- Perform other job duties as assigned
- Bachelor's degree in business administration, healthcare administration, or a related field, or equivalent years of relevant experience is required
- Minimum of five (5) years of experience in claims management or a related field is required
- Minimum of three (3) years of experience with project management is required.
- Facets experience highly preferred
- Proficient with Microsoft Office to include Word, Excel and PowerPoint
- Proven track record of successfully implementing new managed care products
- Strong understanding of the claims processes including but not limited to electronic ingestion, automated adjudication, remittance, reimbursement methodology, and compliance
- Demonstrated in-depth knowledge of Facets, Pre-adjudication, Post-adjudication, Checkwrite, Mass Claims Adjustments, Batch Processing, and Project Management toolset
- Excellent communication and interpersonal skills
- Effective listening and critical thinking skills
- Ability to work effectively in a fast-paced environment
- Strong analytical and problem-solving skills
- Ability to manage multiple priorities and deadlines
- Ability to create and maintain effective working relationships
- Project Management Professional Certificate (PMP) preferred
- General office environment, may be required to sit or stand for extended periods of time
- Ability to travel as required by the needs of the business
- Create an Inclusive Environment
- Cultivate Partnerships
- Develop Self and Others
- Drive Execution
- Influence Others
- Pursue Personal Excellence
- Understand the Business
-
Titan Innovations Huber Heights, United StatesYou support our customers from the financial or insurance industry with their demanding digitization projects as part of the Business Process Management (BPM) team in Huber Heights. You work with state-of-the-art BPM tools such as the Pega platform or, if you feel more at home in ...
-
Crimson Enterprises Preble, United StatesThe Ruhrverband is one of the largest water management companies in Germany and has been ensuring clean rivers and lakes in the Ruhr catchment area for over 100 years. Apply for our Digitalization department at our location in Essen as Project Manager for Digitalization with a fo ...
-
Fishbeck, Thompson, Carr & Huber, Inc. (FTCH) Dayton, United StatesPosition: · Water & Wastewater Process Engineer/Project Manager · Location: · Dayton, OH · Job Id: · 1765 · # of Openings: · 1 · Water & Wastewater Process Engineer/Project Manager · Location · Cincinnati or Dayton, OH · JobSummary · Fishbeck is seeking a Water/Wastewater Pr ...
-
Customer Service Manager
2 days ago
Miller Dayton, United StatesWe are currently seeking a skilled Customer Service Manager to join our team in Dayton, NJ. · - Direct Hire · - On-site · - Dayton, NJ 08810 · - Morning shift · - 8:00am-5:00pm · - 110k yearly · **Responsibilities**: · - Investigates and resolves customer issues such as delayed b ...
-
Customer Service Manager
1 week ago
Miller Dayton, United StatesWe are currently seeking a skilled Customer Service Manager to join our team in Dayton, NJ. · - Direct Hire · - On-site · - Dayton, NJ 08810 · - Morning shift · - 8:00am-5:00pm · - 110k yearly · **Responsibilities**: · - Investigates and resolves customer issues such as delayed b ...
-
HR Specialist
1 day ago
Lighthouse Environmental Services, Inc. Dayton, United States**About us** · We are a pipeline construction, fabrication, maintenance, and integrity management company. · Our work environment includes: · - Casual work attire · - Relaxed atmosphere · - Safe work environment · - Growth opportunities · **Overview**: · **Responsibilities**: · - ...
-
Elemis-retail Operations Coordinator
1 week ago
L'Occitane En Provence Dayton, United States**WHO WE ARE** · We are a skin wellness brand with an aromatherapist's soul, an artist's spirit, and a scientist's commitment to results. An innovative and global British skincare brand with over 30 years of expertise and available in over 100 countries, we believe in 'truth in b ...
-
RN/LPN Unit Manager
2 days ago
The Laurels of Kettering Dayton, United States Full timeAre you an RN looking for a leadership role? Do you have a passion for leading and teaching other skilled nursing staff? The RN Unit Manager provides, plans, coordinates, or manages nursing care and health education for nursing home guests. · The Laurels of Kettering offers one o ...
-
Es&h Transportation Specialist
4 days ago
Targa Resources Dayton, United States***: · The ES&H Transportation Specialist will be located at the Targa Resources Corporate Office and the Dayton Transportation Terminal in Dayton, TX. · This position will be responsible for managing and ensuring compliance with industry safety regulations and hazardous material ...
-
Veterinary Technician
2 days ago
Actalent Montgomery City, United States Full timeDescription: · Maintains care and health needs of the animals using knowledge as a Veterinary Technician · Provides surgical assisting responsibilities including anesthesia charting and monitoring, preparation and sterilization of tools, and operation and maintenance of equipment ...
-
Nurse Practitioner-Carson City, NV
1 week ago
MRG Exams Dayton, United States Full timeWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
Barista
4 days ago
Super Smart Vending Dayton, United StatesJob Overview: · **Responsibilities**: · - Prepare and serve a range of coffee beverages such as espresso, cappuccino, and lattes · - Operate coffee-making equipment including espresso machines and grinders · - Maintain cleanliness and organization of the coffee bar area · - Inter ...
-
Veterinary Technician
1 week ago
Actalent Montgomery City, United States Full timeDescription: · Maintains care and health needs of the animals using knowledge as a Veterinary Technician · Provides surgical assisting responsibilities including anesthesia charting and monitoring, preparation and sterilization of tools, and operation and maintenance of equipment ...
-
Nurse Practitioner
1 week ago
MRG Exams Dayton, United StatesWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
Nurse Practitioner
1 day ago
MRG Exams Dayton, United StatesWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
Nurse Practitioner-Carson City, NV
1 day ago
MRG Exams Dayton, United States Full timeWe are looking for the right Nurse Practitioner to perform medical assessments on United States Veterans as part of the VA's disability benefits process. · In performing Disability Assessments, you will review medical records electronically through a web portal and perform a focu ...
-
IT Support Administrator
1 day ago
Hoxton Circle Dayton, United StatesHoxton Circle has partnered with a specialty retail client that wants to add an on-site part-time IT systems analyst to support up to 35 users. The role is Monday through Thursday onsite part-time up to 30 hours per week in the Dayton, NJ area. Please see duties below. · - Provid ...
-
Warehouse Lead
3 days ago
GXO Logistics Dayton, United States**Logistics at full potential.** · At GXO, we're constantly looking for talented individuals at all levels who can deliver the caliber of service our company requires. You know that a positive work environment creates happy employees, which boosts productivity and dedication. On ...
-
Counselor Iii
1 day ago
Management & Training Corporation Dayton, United States**Overview** · **Pay - $57,160.00 salary** · **Schedule**: · - Full Time, Monday - Friday, 8-hour shifts · **Benefit package includes**: · - Medical, vision, and prescription drug benefits · - Dental benefits · - Life insurance · - Accidental death and dismemberment insurance · - ...
-
Package Handler- Switcher Pt
1 week ago
FedEx Ground Careers US Dayton, United StatesResponsible for the movement of trailers to and from the unload / load doors and throughout the yard. May also be responsible for the physical loading, unloading and/or sorting of packages by hand, including lifting, pushing, pulling, carrying and placing, in a safe and efficient ...
Claims Lifecycle Process Manager - Dayton, United States - CareSource
Description
Job Summary:The Claims Lifecycle Process Manager is responsible for leading and managing the efforts to improve the claim outcomes for existing and new lines of business within the Claims organization. This will involve working closely with cross-functional teams to develop and execute project plans, manage risks, track progress, lead process improvement initiatives, and drive change. A strong understanding of the end-to-end claims process from ingestion to remittance, experience with project management, and excellent communication and interpersonal skills is required.
Essential Functions:
$79, $127,600.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies