Claims Systems Manager

🕒 il y a 11 jours

🐊 Florida, North Carolina, +4 états de plus – Distant

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

💵 $99 963 - $129 952 / an

⏰ Temps Plein

🟠 Senior

🔴 Expert

👔 Manager

👻 Score fantôme 0%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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Partners Health Management

Site WebLinkedInTous les Emplois

201 - 500 employés

Fondée en 2012

🏥 Santé

⚕️ Assurance santé

Healthcare • Healthcare Insurance • Health Care

Partners Health Management est une entité locale de gestion et une organisation de soins intégrés qui se concentre sur la fourniture de services essentiels de santé mentale, de soutien aux personnes ayant des déficiences intellectuelles et développementales, et de services pour les troubles liés à l'usage de substances. Leur mission est d'aider les membres et leurs familles à accéder aux soins et ressources nécessaires pour améliorer leur bien-être général et leur intégration dans la communauté.

Description

• 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

🎯 Exigences

• 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

🏖️ Avantages

• 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