Claim Data Process Manager

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At Emory Healthcare we fuel your professional journey with better benefits valuable resources ongoing mentorshipand leadership programs for all types of jobs and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:

• Comprehensive health benefits that start day 1
• Student Loan Repayment Assistance & Reimbursement Programs
• Family-focused benefits
• Wellness incentives
• Ongoing mentorship development and leadership programs
• And more

Work Location: Atlanta GA

• Plays a key role in protecting the financial stability of Emory University Emory Healthcare and its wholly owned insurance subsidiary Clifton Casualty Insurance Co. Ltd. (CCIC)
• Tracks and creates monthly loss runs that track all payment and reserve-related movement for third party liability matters insured under Emorys Liability Program
• Processes and monitors Emory Medical Professional General Liability and Network Security & Privacy indemnity and expense payments
• Works with CCIC manager and actuary to perform monthly reconciliation of liability loss run insurance program accounting and performance
• This position is also responsible for developing claims data analytics providing data and trends to clinical and other leadership for purposes of quality and patient safety improvements.
• The Claim Data Process Manager will collect data perform statistical analysis create dashboards/ reports and collaborate with teams including Claims Risk Patient Safety Quality and Clinical operating units.
• The goal is to bring awareness to claims holistically to help inform risk patient safety and quality initiatives ultimately to improve patient outcomes and reduce claims and claim costs.
• Management of Financial processes
  • Manage time-sensitive monthly financial data processes including inputting initial reserves and reserve changes as determined by Emorys claims team case settlements legal and related vendor invoices monthly accounting reconciliation and balancing and fiscal year end closing
  • Responsible for running and balancing the monthly loss runs with captive manager and actuary
• Data Analysis & Reporting
  • Collect validate normalize and analyze medical professional and general liability claim data
  • Develop maintain and run standard and ad hoc reports including but not limited to monthly loss runs transaction reports and trend and severity analyses
  • Track and keep current annual liability insurance tower erosion and limit exhaustion reports to track aggregate losses paid/incurred amounts and remaining limits across coverage layers
  • Work with actuarial team to support actuarial analyses by preparing clean accurate datasets for loss projections reserve studies and pricing evaluations
  • Translate complex insurance and claims data into clear actionable insights for leadership risk management legal and finance stakeholders
  • Respond to requests for specific data reports such as claims data Medicaid and Medicare applications
  • Develop dashboards and visual reports to track loss performance emerging risks and program effectiveness
  • Identify opportunities to improve reporting efficiency automation and data accessibility
  • Assist in developing key performance indicators (KPIs) and metrics for insurance program
  • Support internal and external audits by providing accurate timely and well-documented data
  • Support system upgrades data migrations and enhancements related to reporting and analytics; for the claims management system currently RLDatix
• Reinsurance & External Carrier Reporting
  • Work with VP Insurance captive manager and insurance broker to track reinsured losses recoverables ceded premiums and reinsurer participation by layer
  • Support reconciliation of reinsurance payments and recoverables with finance and accounting teams
  • Respond to reinsurer data requests audits and ad hoc reporting needs
• Regulatory & Statutory Reporting
  • Manage and support MMSEA (Medicare Secondary Payer) Section 111 reporting including:
    • Data extraction and validation
    • Timely and accurate submissions to CMS
    • Resolution of CMS errors rejects and compliance issues
  • Support National Practitioner Data Bank (NPDB) reporting by ensuring data accuracy completeness and compliance with reporting thresholds and timelines

MINIMUM QUALIFICATIONS:

• Bachelors degree in a business-related field
• Minimum five (5) years relevant experience
• Knowledge of legal and insurance claims handling principles
• Basic accounting skills ability to navigate various data systems and strong data skills
• Proficiency with data analysis tools SQL BI software (e.g. Tableau Power BI) and statistical techniques
• Presentation skills

JOIN OUR TEAM TODAY! Emory Healthcare (EHC) part of Emory University (EUV) is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet designated ambulatory practice. We are made up of 11 hospitals-4 Magnet designated the Emory Clinic and more than 425 provider locations. The Emory Healthcare Network established in 2011 is the largest clinically integrated network in Georgia with more than 3450 physicians concentrating in 70 different subspecialties.

Emory is an equal opportunity employer and qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability protected veteran status or other characteristics protected by state or federal law.

Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation please contact Emory Healthcares Human Resources at . Please note that one weeks advance notice is preferred.