Health Claims Manager

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Position: Manager of Claims Health Plans (FullTime)

Location : Corvallis OR 97330

Salary: $73000.00 to $90000.00 Per Year with All Benefits.

Hybrid position will be onsite in Corvallis 23 times a week or more if needed. We need a candidate with strong management experience.

JOB SUMMARY/PURPOSE

Oversees and manages the Client Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Client. Provides oversight to staff and ensures that the organizations performance expectations financial standards and goals are achieved. Enhances department bench strength by hiring coaching and mentoring direct reports. Responsible for the completion and success of all internal and external claims audits. Analyzes claims data and ensures compliance requirements are met.

DEPARTMENT DESCRIPTION

Client operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Client offers Medicare Advantage Commercial Large Group and Commercial Large Group PPO and EPO plans; Client is also the thirdparty administrator for Samaritan Health Services selffunded employee health benefit plan. As part of an Integrated Delivery System Client is strategically and operationally aligned with Samaritan Health Services mission of Building Healthier Communities Together.

EXPERIENCE/EDUCATION/QUALIFICATIONS

Bachelors degree in healthcare or a related field or equivalent direct claims experience required.

Three (3) years management experience in a health plan claims department required.

Experience or training in the following required:

Collecting analyzing and displaying statistical reports by computerized technology.

Basic medical terminology.

Medicare and/or Medicaid experience preferred.

KNOWLEDGE/SKILLS/ABILITIES

Leadership Inspires motivates and guides others toward accomplishing goals. Achieves desired results through effective people management.

Conflict resolution Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.

Critical thinking Identifies complex problems. Involves key parties gathers pertinent data and considers various options in decision making process. Develops evaluates and implements effective solutions.

Communication and team building Leads effectively with excellent verbal and written communication. Delegates and initiates/manages crossfunctional teams and multidisciplinary projects