• Amerihealth Caritas Health Plan
  • $107,780.00 -95,690.00/year*
  • Philadelphia , PA
  • Executive Management
  • Full-Time
  • 1103 Market St

Responsibilities:

Under the general direction of the Vice President, Operations, the Director of Claims is responsible for the coordination of all operational management activities related to the Claims unit (claims processing, provider claims services, research and projects).

* This function is responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses/planning and reporting. Includes claims-related business and systems analysis..
* Develops and directs management of Claims function to ensure claims are accurately and promptly paid within Service Level requirements,
* Ensure policies and procedures are uniformly implemented. Identify any procedural deficiencies and implement best practice within the claims industry.
* Establish department objectives and productivity levels
* Investigate and implement, as required, automated solutions for electronic claims records, claims financial, and analytical reporting tools
* Sets performance standards to meet service level agreements (SLA). .
* Responsible for meeting established contractual operational, departmental standards and goals.
* Assists in the development of a consolidated operating budget. Makes efforts to control costs while seeking ways to increase productivity, improve quality and enhance revenue.
* Keeps abreast of new developments in area(s) of responsibility and ensures timely communication to team.
* Works with the Work Force Management function to ensure staffing allocations are developed, managed and assigned based upon production and SLAs.

Education/Experience:

* 8 to 10 years' of management experience. with demonstrated success in managing and motivating a large staff.
* 5 to 7 years' claims center management experience, with experience managing a large claims staff possibly in multiple locations desired.
* Bachelor's Degree required.
* Minimum of 5 years' experience in healthcare, managed care or insurance industry environment required.
* Excellent judgment and decision-making skills.
* Ability to use PC applications in a window based.


Associated topics: advertise, demand generation, event, hospital, marketing, mba, policies, regulatory, relationship, stewardship

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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