Director of Claims & Operations, Healthcare

The Health Plan (THP); Wheeling (WV); On-site; USD 90,000 - 120,000; Full time

Job summary

The Health Plan (THP) in Wheeling, West Virginia is seeking a Director of ASO and HMO claims responsible for managing ASO and HMO products. This role involves leading staff, overseeing claims inventory, and ensuring compliance with payment regulations.

The ideal candidate will have a Bachelor's Degree, extensive experience in healthcare insurance operations, and strong leadership skills. Working hours are from 8:00 AM to 5:00 PM.

Qualifications

• 5+ years of previous claims leadership/management experience.
• Experience with medical claims payment, ICD-10, NDC, HCPCS.
• Strong analytical skills, including excel worksheets/formulas.

Responsibilities

• Directs all aspects of institutional and professional claims review.
• Assists with the development and implementation of claims review procedures.
• Monitors daily activities regarding claims processing and reviews.

Skills

Healthcare insurance operations

Claims leadership/management

Analytical skills

Verbal/written communication

Project Management

Education

Bachelor’s Degree or equivalent experience

Job description

The Health Plan (THP) in Wheeling, West Virginia is seeking a Director of ASO and HMO claims responsible for managing ASO and HMO products. This role involves leading staff, overseeing claims inventory, and ensuring compliance with payment regulations.

The ideal candidate will have a Bachelor's Degree, extensive experience in healthcare insurance operations, and strong leadership skills. Working hours are from 8:00 AM to 5:00 PM.