Senior Claims Manager

Prominence Health; Reno (NV); On-site; USD 90,000 - 150,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Competitive Compensation & Generous Paid Time Off

Excellent Medical, Dental, Vision and Prescription Drug Plans

401(K) with company match

Career development opportunities

Job summary

A healthcare organization in Reno is seeking a Senior Claims Manager to lead the claims department. Responsibilities include overseeing claims operations, providing leadership to a team, and ensuring compliance with Medicare regulations. The ideal candidate has 5+ years of claims management experience and a Bachelor's degree in health care administration or business management. This role offers a challenging work environment and competitive compensation.

Qualifications

• 5+ years’ experience in claims management with direct Medicare claims experience.
• 5+ years’ experience managing operations including budgeting and forecasting.
• Strong ability to influence and persuade while driving collaboration.
• Strong leadership skills with ability to influence and persuade internally and externally while driving cross-functional collaboration.
• In-depth knowledge of medical terminology, CPT/ICD-10, and insurance billing practices.

Responsibilities

• Lead and manage the day-to-day operations of the claims department.
• Oversee a team of claims staff, providing leadership and guidance.
• Collaborate with teams to identify process improvements and ensure compliance.
• Leverage technology to optimize claims workflows.

Skills

Leadership

Claims management

Medicare compliance

Process improvement

Medical terminology knowledge

Claims management

Education

Bachelor’s degree in health care administration or business management

Job description

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members.

Job Summary:

The Senior Claims Manager is responsible for leading and managing the day-to-day operations of the claims department with a focus on accuracy, compliance, and efficiency. This role plays a critical part in ensuring that all claims are processed in accordance with federal, state, and payer requirements while delivering a high level of service to providers, members, and internal stakeholders.

The Senior Claims Manager will oversee a team of claims staff, providing leadership, training, and guidance to drive performance and accountability. In addition to managing operations, this position will collaborate with cross-functional teams to identify process improvements, ensure compliance with Medicare regulations, and leverage technology to optimize claims workflows.

Responsibilities and Qualifications:

• Lead and manage the day-to-day operations of the claims department.
• Oversee a team of claims staff, providing leadership, training, and guidance.
• Collaborate with cross-functional teams to identify process improvements and ensure compliance with Medicare regulations.
• Leverage technology to optimize claims workflows.

Requirements:

• Bachelor’s degree in health care administration or business management, or equivalent work experience.
• 5+ years’ experience in claims management with direct Medicare claims experience.
• 5+ years’ experience managing, budgeting, forecasting and collaboration with executive leadership.
• Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration.
• In-depth knowledge of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices.

Benefits:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.