Job Description :
Dear Candidate,
We are looking for AVP Claims in New York,
Duration- Fulltime
Complete responsibility of all aspects of claims operations, reporting into CIO.
PRIMARY RESPONSIBILITIES:
· Design and develop Claims Operations strategies and work with software / IT vendors, staff and department managers to execute claims processing and servicing activities
· Lead Claims Operations on external matters, such as, regulatory audits and external communication, as well as internal matters, such as, implementations and issue resolution involving across departments.
· Strategize, plan, build team, , and lead the claims related operations of health plans.
· Lead Claims Configuration domain to ensure proper configuration (e.g., benefits, fee schedules, etc and the ongoing setup of providers, contracts, etc. in the claim system.
· Lead the Claims Inventory function to ensure fast & accurate processing of claims, while being in compliance with organizational goals and regulatory guidelines.
· Lead Claims Services domain to ensure the effective handling of provider inquires across multiple incoming channels, fast resolution and the highest level of customer satisfaction.
· Manage the Claims Integrity activities to ensure the consistent encounter reporting to Federal and State agencies, accurate auditing of claims processing results.
· Assure operational excellence and internals as well as regulatory compliance.
Education
· Required: Undergraduate degree in Health, Business Administration or related field.
· Preferred: Graduate Degree in Health, Business Administration or related field.
Mandatory Knowledge and Skills:
· 7+ years’ experience in Managed Care and/or Healthcare Administration
· 5+ years working experience supervising/ managing employees.
· Skills and experiences in implementing systems, processes and procedures for operational excellence
· Demonstrated ability to create, adapt and propagate organizational changes.
· Ability to effectively interact team and/or matrix environment.
· Strong knowledge of Claims and related Operations in the healthcare insurance industry
· Strong organizational, verbal and written communication skills.
Preferred Knowledge and Skills:
· 5+ years’ of hands-on experience in Claims Operations, Processes, procedures and Regulatory Aspects.
· Deep domain knowledge of government programs (Medicare Advantage and Medicaid) related Claims Operations in managed care.
Job Description