Senior Claims Operations Leader

Detroit Wayne Mental Health Authority; Detroit (MI); Sur place; USD 95 000 - 135 000; Plein temps

Résumé du poste

Detroit Wayne Integrated Health Network (DWIHN) seeks a Senior Administrator of Claims to provide strategic leadership for claims administration. You will oversee adjudication, payment processes, and internal controls to ensure accuracy, timeliness, and regulatory compliance across Medicaid/Medicare guidelines and MDHHS requirements.

You will collaborate with executive leadership, finance, IT, and provider networks to improve performance, mitigate risk, and safeguard public funds while driving

Qualifications

• Bachelor's degree is required in a related field.
• 5 years of full-time paid professional experience in claims administration or related field.
• Experience in executive/administrative/management capacity within healthcare.
• Knowledge of Medicaid/Medicare, MDHHS requirements, and payer policies.

Responsabilités

• Oversee and direct the Claims Unit operations, ensuring accurate intake, adjudication, and payment.
• Establish and monitor internal controls to prevent duplicate payments and ensure compliance.
• Lead performance management, reporting, and data-driven improvements across claims processes.
• Collaborate with Finance, Compliance, IT, and other departments to resolve complex claims issues.
• Direct staff supervision and development, and manage vendor relationships as needed.

Connaissances

Strategic leadership

Claims operations

Regulatory compliance

Data analysis

Project management

Formation

Bachelor's degree

Outils

Microsoft Office

Claims systems

Description du poste

Detroit Wayne Integrated Health Network (DWIHN) seeks a Senior Administrator of Claims to provide strategic leadership for claims administration. You will oversee adjudication, payment processes, and internal controls to ensure accuracy, timeliness, and regulatory compliance across Medicaid/Medicare guidelines and MDHHS requirements.

You will collaborate with executive leadership, finance, IT, and provider networks to improve performance, mitigate risk, and safeguard public funds while driving