Senior Claims Operations Lead — Medicaid/Medicare

University Health; San Antonio (TX); Vor Ort; USD 65.000 - 85.000; Vollzeit

Zusammenfassung

Community First Health Plans seeks an experienced claims operations leader to manage analysts, auditors, claims processors and other claims support staff in San Antonio, TX. The role guides day-to-day activities and ensures timely, accurate responses to provider and member inquiries in line with policy.

The position also involves researching escalated provider issues, developing improvement plans for claims procedures, and aligning initiatives with Community First Health Plans' business

Qualifikationen

• Minimum of two years college level work in business, health care administration or a related area.
• Five years of claims experience may substitute college work, with at least two years in a management role.
• Medicaid, Medicare and/or Commercial claims experience strongly required.
• QNXT experience highly desirable.

Aufgaben

• Manages and directs the activities of analysts, auditors, claims processors and other claims support staff.
• Researches and resolves escalated provider issues initiated by claim processors.
• Provides written and telephonic resolutions to external customer issues (with both providers and members) in accordance with the health plan's policies and procedures.
• Develops claim procedure improvement methodology(s), directions and strategic plans for procedural improvement to support Community First Health Plans' (Community First) business plan.

Kenntnisse

Claims management

Leadership

Provider relations

Quality assurance

Ausbildung

Two years college level work in business/health care administration

Jobbeschreibung

Community First Health Plans seeks an experienced claims operations leader to manage analysts, auditors, claims processors and other claims support staff in San Antonio, TX. The role guides day-to-day activities and ensures timely, accurate responses to provider and member inquiries in line with policy.

The position also involves researching escalated provider issues, developing improvement plans for claims procedures, and aligning initiatives with Community First Health Plans' business