Senior Manager, Claims - Cfhp

University Health; San Antonio (TX); In loco; USD 70.000 - 90.000; Tempo pieno

Descrizione del lavoro

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.

Competenze

• 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.

Mansioni

• 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.

Conoscenze

People management

Claims processing leadership

Issue resolution

Analytical skills

Policy adherence

Formazione

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

Strumenti

QNXT

Descrizione del lavoro

POSITION SUMMARY/RESPONSIBILITIES

Manages and directs the activities of analysts, auditors, claims processors and other claims support staff as assigned. 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.

EDUCATION/EXPERIENCE

Minimum of two years college level work in business, health care administration or a related area is required. College requirement may be substituted for five years claims experience, including two years at the management level. Medicaid, Medicare and/or Commercial claims experience is strongly required. QNXT experience highly desirable.