Remote Leader, Payment Integrity & Claims Savings

Highmark Health; Northern (KY); Hybrid; USD 86,000 - 139,000; Full time

Job summary

Highmark Inc. is seeking a Manager of Payment Integrity to oversee the pre-payment high dollar claims review process, coordinating with Utilization Management, Facility Revenue Cycle teams and Provider Relations. Responsibilities include guidance on audits, system improvements and achieving annual savings targets.

The role requires 5 years in operational claims and 3 years in a leadership position, with strong analytical, forecasting and Excel skills. Remote work with some travel is possible.

Qualifications

• Bachelor’s degree in Business Administration/Management.
• 5 years in Operational Claims.
• 3 years in a management or leadership role.

Responsibilities

• Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Plan and assign personnel, provide project oversight and ensure work accuracy on Payment Integrity related claims audits.
• Provide instructions and direction regarding technical solutions to business issues; anticipate impact and propose solutions.
• Communicate issues and resolutions within Operations and with FPIR, Provider Relations and Sales.
• Represent Highmark as the key contact for the High Dollar Claims process and drive process improvements.

Skills

Analytical Skills

Change Control

Claims/Benefit Systems

Financial Forecasting/Modeling

Microsoft Excel

Health Care Operations

Education

Bachelor's Degree in Business Administration/Management

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

Job description

Highmark Inc. is seeking a Manager of Payment Integrity to oversee the pre-payment high dollar claims review process, coordinating with Utilization Management, Facility Revenue Cycle teams and Provider Relations. Responsibilities include guidance on audits, system improvements and achieving annual savings targets.

The role requires 5 years in operational claims and 3 years in a leadership position, with strong analytical, forecasting and Excel skills. Remote work with some travel is possible.