Senior Claims Operations Leader

University Health; San Antonio (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

University Health seeks a claims leadership professional to manage and direct analysts, auditors, and claims staff. The role addresses escalated provider issues and delivers written and telephonic resolutions to providers and members in line with health plan policies.

The candidate will develop claim procedure improvements and strategic plans to support Community First Health Plans’ business goals, with strong Medicaid/Medicare and commercial claims experience and QNXT familiarity valued.

Qualifications

• Two years of college-level study in business, health care administration, or a related field.
• Alternatively five years of claims experience with at least two years in management.
• Medicaid/Medicare/commercial claims experience strongly required.
• QNXT experience highly desirable.

Responsibilities

• Manage and direct activities of analysts, auditors, and claims staff.
• Research and resolve escalated provider issues raised by claim processors.
• Provide written and telephonic resolutions to external provider and member issues.
• Develop claim procedures and strategic plans to improve processes for the health plan.

Skills

People management

Claims processing leadership

Issue resolution

Analytical skills

Policy adherence

Education

Two years college-level work in business/health care administration

Tools

QNXT

Job description

University Health seeks a claims leadership professional to manage and direct analysts, auditors, and claims staff. The role addresses escalated provider issues and delivers written and telephonic resolutions to providers and members in line with health plan policies.

The candidate will develop claim procedure improvements and strategic plans to support Community First Health Plans’ business goals, with strong Medicaid/Medicare and commercial claims experience and QNXT familiarity valued.