Supervise and provide leadership and guidance to Claims Analysts and support staff regarding company policies, procedures and workflow applicable to groups/individuals and/or self-funded clients. Manage claims production and quality that meets or exceeds company standards. Resolve claims adjudication issues. 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. Experience in self-funded claims administration helpful.
Education, Certificates, Licenses: Requires high school diploma or equivalent.
Knowledge: Perform the essential functions and meets all of the qualifications of the Claims Analyst III position. Thorough understanding of PacificSource products, plan designs, provider relationships and health insurance terminology. Basic working knowledge of Oregon Insurance Division rules and regulations. Thorough understanding of claims processing system and operation. Advanced PC skills including, Microsoft Word and Excel. Ability to type using a standard keyboard, operate 10-key pad accurately, multi-line telephone system, and fax machine. 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. Current knowledge of changes in PacificSource business processes and procedures and relating that information to team members. Ability to work under time pressures and deal with difficult situations. Team player. Collaborates with others and helps to 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.
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.