Director of Claims for an Innovative Healthcare Solutions Provider

Area : National

Description : Our client is an innovative healthcare solutions provider dedicated to serving the agricultural community. They are seeking a highly motivated and strategic Director of Claims to oversee and guide all Claims Operations within their organization.

Responsibilities:

- Responsible for overseeing and leading the entire lifeline of Claims being processed

- Possession of excellent negotiation skills

- High-level leadership experience and ability to train employees to audit and correct claims

- An understanding of the high-level overview of the claims departments and the ability to make strategic decisions when needed

- Partner with the HR department to oversee the Claim department's interview, hiring, and termination process

- Serve as a liaison between the Customer Service, Client Services, Billing, and Claims departments

- Develop and implement changes impacting the claims department and conduct training and implementation as needed

- Serves as a subject matter expert in Claims when needed to provide training to members and staff.

- Cultivate and build strong working relationships with the outside vendors, BSC, FDH, FHN

- Revise, update and create procedures to improve the efficiency of the workflow as needed in a timely manner

Qualifications:

- Prior experience in claims operations within the healthcare field

- High degree of knowledge of health plan benefits in a leadership role

- Bachelor’s degree in a related field

- 10-15 years’ experience overseeing and leading the Claims department, processing claims, and training, etc.

- Proficient in Outlook, Windows platforms, Excel, and spreadsheet software

- Exceptional organizational, time management, and problem-solving skills

- Extensive knowledge of medical and dental insurance concepts, practices, payments, terminology, and procedures

- Knowledge of ERISA, California Department Insurance Regulations, and self-funding arrangements

 

Published : Jan 22, 2021

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