Healthcare Claims Systems Lead

LINECO; Lombard (IL); On-site; USD 105,000 - 140,000; Full time

Benefits offered by this job

Employer-funded health plan

Job summary

LINE Construction Benefit Fund (LINECO) seeks a highly organized Claims System Manager to oversee the architecture of IBM systems and SaaS-based claims adjudication software for medical and dental benefits.

The role collaborates with the Claims Processing Department to set strategic direction for daily claims administration, electronic workflows, and benefit templates, ensuring accuracy and efficiency across programs.

Qualifications

• Bachelor’s degree or 5+ years’ independent work in health insurance/payor role.
• 3 years project management on large multi-million-dollar healthcare projects.
• Strong communication with senior management across departments.
• Experience researching issues using databases/systems.

Responsibilities

• Track project progress, milestones, issues, and reporting.
• Develop and maintain an audit tool for group setup and go-live processes.
• Evaluate projects for quality assurance and cost-effectiveness.
• Create process flows to streamline workflows and SOPs.
• Organize and participate in meetings to foster a shared approach.

Skills

Project management

Communication

Analytical thinking

EDI & claims processing

Software integration

Education

Bachelor's degree or equivalent healthcare/payor experience

5+ years independent work in health insurance/payor role

Tools

Access

Excel

Word

PowerPoint

IBM applications

Job description

LINE Construction Benefit Fund (LINECO) seeks a highly organized Claims System Manager to oversee the architecture of IBM systems and SaaS-based claims adjudication software for medical and dental benefits.

The role collaborates with the Claims Processing Department to set strategic direction for daily claims administration, electronic workflows, and benefit templates, ensuring accuracy and efficiency across programs.