Manager Claims Processing
3.
5 Boise, ID Boise, ID Full-time Full-time Estimated:
$80.
6K - $102K a year Estimated:
$80.
6K - $102K a year 6 days ago 6 days ago 6 days ago Overview:
St.
Luke's Health System is seeking a Manager Claims Processing - St.
Luke's Health Plan to join our team.
Unit/Position Summary Manager Claims Processing is responsible for oversight of all operational management activities related to claims processing.
Works closely with all areas of the Health Plan to effectively process and pay claims in a timely manner and in compliance with federal and state regulations.
Develops workforce strategy that aligns with culture and attracts, retains, and develops talent that meets the evolving needs of the St.
Luke's Health Plan.
Communicates with stakeholders to ensure dependencies and strategies are well understood.
Oversees all claims inventory and aging using data, technology, and innovation.
Drives high performing team growth with continuous improvement to identify, assess, and resolve issues.
Responsibilities:
Responsible for directing the development, documentation, implementation, and evaluation of policies and procedures that assure accurate, timely claims processing.
Collaboration and communication with other departments on claims issues, related projects, and inter-departmental operations issues.
Develop effective, actionable solutions.
Responsible for managing all claims inventory and aging using data, technology, and innovation.
Responsible for ensuring contractual obligations are met, regulatory timeframes are adhered to, and customers are provided with a high level of service.
Responsible for developing, managing, and maintaining staffing plans to support fluctuating claim and adjustment volumes, driven by new business, new products, or department changes that are designed to meet or exceed the defined performance standards.
Ensure department achieves all department/company goals, as well as adherence to department/company policies and procedures.
Maintains quality service by enforcing quality and customer service standards.
Analyzes and resolves quality and customer service problems and recommends system improvements.
Defines objectives, identifies trends and options, chooses a course of action, and evaluates outcomes.
Ongoing focus on scalability, automation, and continuous process improvements.
Liaison between claims and configuration to ensure claims rules are implemented and claims are processed accurately.
Proactively monitor and ensure that the claims department complies with applicable state, federal, and HIPAA requirements while meeting contracted client service agreements.
Examine complex information and situations, evaluate the potential impact, identify options, and make recommendations.
Establish and maintain effective working relationships.
Responsible for full employment life cycle for staff to include hiring, termination, performance management, coaching, training, and mentoring to staff.
Perform other duties and responsibilities as assigned.
Qualifications:
Education:
Bachelor's degree or experience in lieu of
Experience:
5 years' experience Licenses/Certifications:
None.
Estimated Salary: $20 to $28 per hour based on qualifications.
5 Boise, ID Boise, ID Full-time Full-time Estimated:
$80.
6K - $102K a year Estimated:
$80.
6K - $102K a year 6 days ago 6 days ago 6 days ago Overview:
St.
Luke's Health System is seeking a Manager Claims Processing - St.
Luke's Health Plan to join our team.
Unit/Position Summary Manager Claims Processing is responsible for oversight of all operational management activities related to claims processing.
Works closely with all areas of the Health Plan to effectively process and pay claims in a timely manner and in compliance with federal and state regulations.
Develops workforce strategy that aligns with culture and attracts, retains, and develops talent that meets the evolving needs of the St.
Luke's Health Plan.
Communicates with stakeholders to ensure dependencies and strategies are well understood.
Oversees all claims inventory and aging using data, technology, and innovation.
Drives high performing team growth with continuous improvement to identify, assess, and resolve issues.
Responsibilities:
Responsible for directing the development, documentation, implementation, and evaluation of policies and procedures that assure accurate, timely claims processing.
Collaboration and communication with other departments on claims issues, related projects, and inter-departmental operations issues.
Develop effective, actionable solutions.
Responsible for managing all claims inventory and aging using data, technology, and innovation.
Responsible for ensuring contractual obligations are met, regulatory timeframes are adhered to, and customers are provided with a high level of service.
Responsible for developing, managing, and maintaining staffing plans to support fluctuating claim and adjustment volumes, driven by new business, new products, or department changes that are designed to meet or exceed the defined performance standards.
Ensure department achieves all department/company goals, as well as adherence to department/company policies and procedures.
Maintains quality service by enforcing quality and customer service standards.
Analyzes and resolves quality and customer service problems and recommends system improvements.
Defines objectives, identifies trends and options, chooses a course of action, and evaluates outcomes.
Ongoing focus on scalability, automation, and continuous process improvements.
Liaison between claims and configuration to ensure claims rules are implemented and claims are processed accurately.
Proactively monitor and ensure that the claims department complies with applicable state, federal, and HIPAA requirements while meeting contracted client service agreements.
Examine complex information and situations, evaluate the potential impact, identify options, and make recommendations.
Establish and maintain effective working relationships.
Responsible for full employment life cycle for staff to include hiring, termination, performance management, coaching, training, and mentoring to staff.
Perform other duties and responsibilities as assigned.
Qualifications:
Education:
Bachelor's degree or experience in lieu of
Experience:
5 years' experience Licenses/Certifications:
None.
Estimated Salary: $20 to $28 per hour based on qualifications.
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