Claims Manager-Payment Integrity


As a Payment Integrity Manager, you will support the Payment Integrity Team with the management and implementation of projects and process improvements in Service Operations with special focus on claims processing. At the same time, you will support the Service Operations Team on overarching projects and strategies to achieve the metrics.

In this role, you will interface with a variety of business partners, external vendors, technology specialists and managers. The successful candidate in this role will have experience in leading teams focused on using data to identify opportunities to improve outcomes, and an interest in project development and final implementation.

Job content:

* Recommend, support and implement innovative strategies to improve overall payment integrity, in a cost effective manner.

* Play active role in projects and process improvements including being the focal contact person for all stakeholders to gather requirements, guide and develop action plans and implementation strategies.

* Be proactive in identifying improvement/enhancement opportunities and active in seeking and sharing ideas for innovation in business processes across operations.

* Support the Payment Integrity Team in achieving departmental and company-wide goals and business plans.

* Support Service Operations Team in achieving the overall metrics, work on improvement actions across the teams and engage the teams in payment improvement actions.

* Communication of outcomes at all levels of the organization

* Support team members through continual engagement, focused on professional development

* Reduce medical and operational cost through innovative strategies

Specific Knowledge:

* 5 years of experience in operations; health care or medical industry preferred

* Bachelor's degree highly preferred

* Claims knowledge and experience preferred

* Proven leadership or management experience required

* Working knowledge with government programs preferred

* Ability to manage succefully internal relationships with cross fuctional teams

* Demonstrated business process analysis skills

* Successful track record of timely delivery of tasks with high quality and eye for detail

* Proven ability to get into the details of projects in order to drive them to successful execution

* Experience in owning and driving user acceptance testing and business adoption

* Ability to multi-task

* Advanced knowledge of Microsoft Office - and proprietary IT applications

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