Manager Claims Administration
Manager Claims Administration
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Job Description
We are searching for a Manager of Claims Administration someone who works well in a fast-paced setting. In this position you will plan develop and implement Claims Processing functions and related processes for the Claims Administration Department.
Think youve got what it takes
Job Duties & Responsibilities
Plan develop organize and implement processes to ensure timely and accurate claims processing.
Plan develop organize and implement processes to ensure claim adjustments appeals and correspondence is completed timely and accurately.
Develop policies and procedures and systems for a Pediatric MCO based on the integrated delivery system goals and objectives and which meet the performance goals and measurements.
Mentor and develop Claims Processing staff toward expansion of job roles to meet the continuous challenges and changes of the health care environment contracts and governmental regulations including promoting the ability to respond effectively to innovative initiatives.
Review and implement Texas Department of Insurance regulations pertaining to HMOs
Review and implement HHSC statutory reporting requirements of Texas Medicaid
Skills & Requirements
High School Diploma or equivalent
7 years of Health Plan Claims Administration or related experience
Bachelors degree will substitute for four (4) years of experience
Required Experience:
Manager
Employment Type
Full-Time
