Position Overview: Responsible for all aspects of the operations for the Government (Medicaid and Medicare) Claims Department. Establish, monitor, and continuously improve processes and supporting policies and procedures that ensure the timely and accurate processing of claims. Lead multiple teams supervised by Team Leaders to achieve department goals and metrics. Collaborate with other departments to meet customer needs and improve the overall operational efficiency within the company. Manage relationships and performance of vendors utilized for claims processing. Provide coaching and development for Team Leaders and others in the claims department. Develop budgets and manage spending within established budgets. Lead change and encourage innovation and process improvement. Ensure PacificSource’s reputation as a provider of outstanding service by supporting the vision, mission, and values of the organization.
Actively participate as a key team member in manager/supervisor meetings.
Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
Responsible for hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
Meet department and company performance and attendance expectations.
Perform other duties as assigned.
Work Experience: Minimum five years health insurance operations or similar experience. Medicare and Medicaid experience preferred. A minimum of two years of management experience required.
Education, Certificates, Licenses: Requires high school diploma or equivalent. Bachelor’s degree preferred. Advanced skills in medical terminology, CPT/ICD-9/10 coding is desired.
Knowledge: Effective and responsive leader. Thorough understanding of PacificSource products, plan designs, provider relationships and health insurance terminology. Basic working knowledge of applicable Federal and State rules and regulations. Understanding of claims processing system and operations. Consistently helpful, confident, and pleasant with all types of customers, both internal and external. Ability to clearly communicate with co-workers and takes proactive, as well as responsive, action to ensure good service. Ability to work under time pressures and deal with difficult situations. Advanced PC skills, including ability to type using a standard keyboard and operate a 10-key pad accurately, word-processing skills, and spreadsheet data management and software skills. Team player. Collaborates with others and helps to accomplish objectives.
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.
Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.