Claims Operations Director

Capital Health Plan; Tallahassee (FL); On-site; USD 80,000 - 100,000; Full time

Job summary

A healthcare solutions provider located in Tallahassee is seeking a leader for claims administration to ensure accurate processing of claims and recoveries. Responsibilities include managing billing reconciliation and contract administration, alongside leading staff in claims integrity analysis. Ideal candidates will possess a bachelor's degree and ten years of related experience, along with strong oversight skills for software enhancements and claims management processes.

Qualifications

• Bachelor's degree or one to two years related experience and/or training.
• Ten years related experience preferred.

Responsibilities

• Direct activities of claims administration staff for timely processing.
• Oversee billing and premium payment reconciliation.
• Manage contract administration and software updates.
• Conduct root cause analysis of claims issues.

Education

Bachelor's degree (BA/BS) from four-year college or university

Job description

Department:

Claims

Schedule/Hours:

As required

Job Summary:

Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries. Directs the activities related to billing and reconciliation of premium payment by employers and individuals. Directs the activities of contract administration function in appropriate and timely software updates, code/fee configurations, and overall provider and contract administration. Directs the activities of payment integrity staff in root cause analysis of claims related issues, third party vendor oversight, and claims related risk adjustment processes. Supports the implementation of software enhancements.

Minimum Qualifications:

Bachelor's degree (BA/BS) from four-year college or university; or one to two years' related experience and/or training; or equivalent combination of education and experience. Ten years related experience preferred.