Manager, Payment Integrity & High-Dollar Claims

Highmark; United States; Sur place; USD 8 600 - 139 000; Plein temps

Résumé du poste

Highmark Inc. seeks a leader to oversee the pre-payment high-dollar claims review process with cross-functional coordination across Utilization Management, Facility Revenue Cycle, Provider Relations, and Sales.

You will review itemized bills for savings on outlier claims and work with the team to ensure payment accuracy. The role requires extensive operational claims experience and leadership, focusing on system improvements, risk mitigation, and delivering annual savings targets through

Qualifications

• Bachelor's degree in Business Administration/Management required.
• 6 years of related experience in lieu of a Bachelor's Degree allowed.
• 5 years in Operational Claims and 3 years in a management role required.

Responsabilités

• Oversee day-to-day operations of the Payment Integrity department.
• Plan, staff, direct and control operations; manage budgeting if applicable.
• Supervise staff and drive accuracy in claims audits and system enhancements.
• Coordinate with FIPR, Provider Relations, and Sales to resolve issues.
• Support realignment to achieve annual savings targets.

Connaissances

Analytical Skills

Change Control

Claims/Benefit Systems

Financial Forecasting/Modeling

Microsoft Excel

Health Care Operations

Formation

Bachelor's Degree in Business Administration/Management

6 years of related experience in lieu of a Bachelor's Degree

Description du poste

Highmark Inc. seeks a leader to oversee the pre-payment high-dollar claims review process with cross-functional coordination across Utilization Management, Facility Revenue Cycle, Provider Relations, and Sales.

You will review itemized bills for savings on outlier claims and work with the team to ensure payment accuracy. The role requires extensive operational claims experience and leadership, focusing on system improvements, risk mitigation, and delivering annual savings targets through