Supervise and provide guidance to Third Party Recovery Representatives regarding company policies, procedures, and workflow. Manage third party recovery functions for efficiency, timeliness, and quality. Resolve third party issues and oversee tracking and reporting of third party savings. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team support, manage change and encourage innovation, build collaborative relationships, encourage involvement and initiative, and develop increased vision and commitment to goals in others.
Work Experience: Minimum of four years claims adjudication experience and qualified to take on leadership responsibilities, or equivalent experience in a related health field. 1 year supervisory experience preferred. Experience in self-funded claims administration also preferred.
Education, Certificates, Licenses: Requires high school diploma or equivalent.
Knowledge: Ability to gain a thorough understanding of PacificSource products, plan designs, provider relationships, and health insurance terminology. Basic working knowledge of Oregon Insurance Division rules and regulations, as well as third party claims administration procedures and third party carrier provisions. Thorough understanding of claims processing system and operation. Advanced PC skills including, Microsoft Word and Excel. Research skills and ability to evaluate claims in order to audit accurately. Advanced skills in medical terminology, CPT / ICD-10 coding. Effective and responsive leader. Excellent communication skills. Ability to work under time pressures and deal with difficult situations. Team player. Collaborate with others and help accomplish objectives. Strong work ethic and ability to work effectively with a variety of personalities at varying skill levels.
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.