Claims Manager

Prominence-Health-Plan; Reno (NV); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Challenging and rewarding work enviro​

Competitive compensation & generous PA

Excellent Medical, Dental, Vision and

401(K) with company match and stock

SoFi Student Loan Refinancing Program

Career development opportunities

Job summary

Prominence Health is seeking a Claims Manager to oversee claims for Commercial, ASO and Medicare products, provide staff training, and coordinate interactions with multiple health plan departments. You will ensure timely claim payments and resolve payment and benefit questions.

Founded in 1993 and now part of Universal Health Services, Prominence Health serves a broad network of providers and members, offering career growth and strong benefit programs.

Qualifications

• Bachelor's Degree or equivalent experience.
• Five or more years in a health plan environment.
• Five or more years in Medicare/Medicaid claims processing.
• At least two years supervisory experience.
• Minimum two years' experience in advanced computer systems.
• Excellent English communication skills.
• Proficiency with Microsoft Excel, Word and Access.
• Ability to plan, organize, and meet deadlines.
• Strong interpersonal and teamwork skills with a commitment to quality service.
• Ability to maintain confidentiality.
• Ability to work with diverse groups and build relationships.
• Ability to identify trends and recommend corrective actions.

Responsibilities

• Manage claims for Commercial, ASO and Medicare products.
• Provide training to staff per contracts, rules, regulations, policies and procedures.
• Oversee and coordinate interaction with various health plan departments.
• Coordinate production of all health plan products ensuring timely claim payments.
• Resolve questions regarding claim payments and benefits.

Skills

Health plan experience

Supervisory experience

Claims processing

English communication

Education

Bachelor's Degree or equivalent experience

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Job description

Responsibilities

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

This position reports to the Director of Operations and is responsible for the managing claims for Commercial, ASO and Medicare products. Provide training to staff in accordance with contracts, rules, regulations, company policies and procedures. Oversees and coordinates interaction with various health plan departments. Coordinates production of all health plan products ensuring that all claims are paid in a timely manner. Responsible for resolving questions regarding claim payments and benefits.

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications

Qualifications and Requirements:

• Bachelor's Degree or equivalent experience
• Five (5) years minimum experience in a health plan environment.
• Five (5) years minimum experience in Medicare/Medicaid claims processing.
• At least two (2) years previous supervisory experience.
• Minimum two (2) years' experience in advanced computer systems
• Ability to effectively communicate in English, both verbally and in writing.
• Excellent Skills in Microsoft Excel, Word and Access.
• Ability to plan, organizes, and maintains priorities and schedules, as well as assured that deadlines are met.
• Excellent verbal and written communication skills, organizational skills, ability to interpret and apply established policy and procedure for all Health Plans products.
• Excellent human relation skills in interpersonal contracts, high personal motivation and ability to work independently, high professional judgment and behavior.
• Evidence of team collaboration, creativity, integrity, self-confident and have a commitment to quality service.
• Ability to maintain confidentiality.
• Interpersonal skills necessary to deal with a diverse group of individuals as well as establish strong cooperative working relationships.
• Ability to identify trends, potential problems and recommend corrective action and/or program/procedural development.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.