Claims Senior Manager - Bloomington, MN, United States
3 hours ago
Job description
DescriptionHealthPartners is hiring a Claims Senior Manager. This position is accountable for managing the daily operations and personnel for Claims all activities necessary for timely, accurate and efficient processing of all products. This includes the administration of Coordination of Benefits and subrogation provisions. Work and collaborate with all levels of staff within the organization, provider leadership and management of Claims staff, staffing analysis and meeting key customer metrics. Develop team members for growth and leadership within the organization.
ACCOUNTABILITIES:
- Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
- Management leadership for designated claims department and its day to day activities. Including coaching/training staff to maintain high service standards and meet regulatory requirements.
- Participates in the continuing process of automation in the Claim Department to enhance claim processing and data integrity. Facilitates collection of statistical data and reports for health plan, clinic staff and group policyholders.
- Conducts analysis of claims data to determine recommendation for changes or modification to programs to the Director, Claims.
- Facilitate communication with business functional leaders, Medical Director, Clinic Managers, Information Services staff, senior management and officers regarding operations and functional areas of development, claims analysis and impact of new business initiatives, regulatory changes and strategic projects.
- Provide leadership in cross-functional and intercompany workgroups related to new initiatives.
- Conducts investigation and evaluation of member claim complaints routed from the Claims Customer Service Examiner staff and Member Services department and approves appropriate adjustments.
- Establishes and maintains active communication with providers of service to encourage problem solving and an exchange of information that fosters coordination of care for health plan members.
- Conducts and/or participates in organizations committee meetings as required. Provides staff assistance to the Member Appeals Sub-Committee of the Board in the absence of the Director of Claims.
- Ensures accurate administration of member benefits, medical policy and provider reimbursement for all products. Ensures optimum benefit dollar recovery through third party liability provisions and claim refund activity.
- Participates in departmental planning as it relates to objectives, cost containment, future systems and division/corporate policies.
- Responsibility for compliance with Federal and State regulations affecting Claims and operational units, support accreditation requirements.
- Define Business Continuity plans to ensure operational effectiveness
- Assist in coordinating department audits and audit readiness for state, federal and accreditor agencies.
- Prepare annual budget, department goals/objectives and long range strategic planning for the. Maintains departmental expenditures within budget limitations.
- Assures that GHI's EEO/Affirmative Action Program is properly communicated, implemented and adhered to in an effort to achieve projected goals on corporate and divisional basis.
- Develop and maintain a broad base knowledge of health care industry and claims management. As well as HealthPartners administrative functions and systems
Performs other duties as required.
REQUIRED QUALIFICATIONS:
- College degree with emphasis in business administration or equivalent experience in the management of a production area.
- Five years' experience in the health insurance industry including 3 years in supervisory/management role.
- Five years of proven experience as a claims leader or similar position with experience in health plan operations...
- Concise and accurate written communication skills.
- Ability to make oral presentations and lead discussions
- Advance human relations skills
- Advanced analytical skills
- Advanced problem solving skills
- Detailed knowledge of the health care industry, including customer expectations on service and cost containment.
- Demonstrated skill in planning, organizing and time management.
- Ability to make logical decisions and meets deadlines.
- Ability to analyze and interpret data and communicate action plans via written documentation.
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