Claims Systems Manager

🕒 Outubro 14

🐊 Florida, North Carolina, +4 estados a mais – Remoto

🐊 Florida – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $99.963 - $129.952 / ano

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

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• Aberta há 28 dias.
• As vagas desta empresa costumam ser preenchidas em 38 dias.

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Partners Health Management

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2012

🏥 Saúde

⚕️ Seguro de Saúde

Healthcare • Healthcare Insurance • Health Care

A Partners Health Management é uma entidade local de gestão e uma organização de cuidado gerenciado que se concentra na oferta de serviços essenciais de saúde mental, apoio para indivíduos com deficiências intelectuais e de desenvolvimento e serviços para transtornos por uso de substâncias. Sua missão é ajudar os membros e suas famílias a acessarem os cuidados e recursos necessários para melhorar seu bem-estar geral e integração na comunidade.

Descrição

• Provide strategic leadership and oversight to the Claims Systems Analyst Supervisor(s) team • Hire, supervise, evaluate, and mentor the Claims System Analyst team • Monitor workload and business requirements to maintain adequate staffing and productivity • Facilitate the design, development, implementation, and operation of claims management and associated software systems • Provide daily status updates to upper management as directed by the VP of Business Services • Monitor, track, and escalate Business Requirements Documents, vendor contracts, and service desk ticket resolution • Oversee and participate in software application selection, implementation, and maintenance • Allocate project and support resources in alignment with divisional and organizational priorities • Complete project reports and documentation on project health and status • Develop and communicate organizational vision and direction to the Claims System team and stakeholders • Ensure complex projects align with ISD architecture, infrastructure, and business goals • Identify and define the claims management system vision, roadmap, and growth opportunities • Evaluate and prioritize feature backlogs and development requests • Manage vendor relationships and act as an escalation point for staff and stakeholders • Coordinate across ISD teams to prioritize and deliver projects, reports, and enhancements within stated timeframes • Ensure claims management technologies are used according to policies and procedures • Apply knowledge of North Carolina Medicaid rules and regulations • Perform other duties as assigned

🎯 Requisitos

• Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or closely related field • Seven (7) years of experience in management of data systems, with focus on claims or health insurance systems a plus • Minimum of five (5) years of experience in a management/supervisory role • In-depth understanding of physical and behavioral health claims processing software systems • Knowledge of insurance principles, practices, federal and state regulations, and North Carolina Medicaid rules and laws • Understanding of project management methodologies and tools • Knowledge of business analysis techniques and tools, including creation and management of Business Requirement Documents • Proven ability to lead and manage medium to large teams effectively • Exceptional written and verbal communication skills • Excellent analytical and problem-solving skills • Proficiency with claims management software, data analysis tools, project management software, Microsoft O365 suite, and service desk ticketing software • Ability to create reports, pivot tables, and presentations • Ability to manage vendor relationships and use conflict resolution methods • Ability to define and implement strategic roadmaps aligned with organizational goals • Keen attention to detail and ability to ensure accuracy and compliance • Ability to make informed decisions quickly and effectively • Ability to cultivate working relationships with internal and external stakeholders • Must live in Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia

🏖️ Benefícios

• Annual incentive bonus plan • Medical, dental, and vision insurance with low deductible/low cost health plan • Generous vacation and sick time accrual • 13 paid holidays • State Retirement (pension plan) • 401(k) Plan with employer match • Company paid life and disability insurance • Wellness Programs • Public Service Loan Forgiveness Qualifying Employer

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