Claims Systems Manager

Job not on LinkedIn

🔥 7 minutes ago

🐊 Florida, North Carolina, +4 more states – Remote

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

💵 $100k - $130k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

👻 Ghost score 0%

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Partners Health Management

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Health Care

Partners Health Management is a local management entity and managed care organization that focuses on providing essential mental health services, supports for individuals with intellectual and developmental disabilities, and substance use disorder services. Their mission is to assist members and their families in accessing the necessary care and resources to improve their overall well-being and integration into the community.

📋 Description

• Provide strategic leadership and oversight to Claims Systems Analyst Supervisor(s) and the Claims System Analyst team • Hire, supervise, evaluate, and mentor team members • 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 Requirement Documents, vendor contracts, and service desk ticket resolution • Oversee and participate in software application selection, implementation, and maintenance • Allocate project and support-request resources in alignment with organizational priorities and deadlines • Complete project reports and documentation on project health and status • Develop and communicate organizational vision and direction throughout projects • Ensure complex projects align with architecture, infrastructure, and business goals • Define the claims management system vision, roadmap, and growth opportunities • Evaluate and prioritize the feature backlog and development requests • Manage vendor relationships and act as an escalation point • Coordinate 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

🎯 Requirements

• 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’ 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 in 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 relationships with internal and external stakeholders • Must live in Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia

🏖️ Benefits

• 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