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Manager Claims Systems - EviCore - Remote
About the position
The Manager of Claims Systems will own process design, tactical implementation and execution of strategies within the Claim Systems and Configuration teams through delegation or personal execution. The position oversees the day-to-day operations with ultimate responsibility for the successful completion and quality of claims systems deliverables. This position will perform duties under self-direction, have decision making responsibilities and act under the supervision of and assist the Sr Manager of Claims Systems, as needed.
Responsibilities
- Oversight of Claims Systems initiatives change control, risk assessment/management, impediment removal, as well as progress reporting to the Director of Claims Systems and/or other leadership, as required.
- Collaborate with the Claims Business Process Solutions, Claims Business Intake Team and Claims Product and Planning team for claims backlog governance workflow input, process improvement initiatives and resource impediments solutions.
- Provide input, as needed, toward LBC and OC discussions with Claims Leadership and Product and Planning resources.
- Through personal execution or delegation, ensure creation/maintenance of departmental work instructions, policies and workflows required to ensure success of deliverables and transition of knowledge to team members and other internal departments.
- Provide final approval of department work instructions, policies, workflows and training, as well as ensure audits are performed to verify adherence is met appropriately and timely.
- Motivate and guide the department to meet and exceed all goals and objectives as set forth by leadership.
- Support team Supervisors and Trainers regarding knowledge growth (i.e. platform, program, process, etc.).
- Support team Supervisors in personnel activities (i.e., time and attendance, recruitment, annual performance evaluations, payroll, disciplinary procedures, training, etc.).
- Oversight of departmental audit control maintenance, adherence to audit controls and audit control artifacts are accessible upon request through collaboration with the Compliance team.
- Provide support to Claim Systems resources to overcome knowledge impediments or client escalations, which the Trainer and Supervisors are unable to overcome, through appropriate channels of support available both internally and externally.
Requirements
- High School Diploma required, Bachelor’s degree preferred.
- 5+ years of healthcare claims life cycle and client/vendor relationship experience, with an emphasis in healthcare claims system configuration/implementations.
- 2+ years of supervisor experience
- Proficient in Excel, Word and Access, required.
- Knowledge of SQL data query.
- Experience in claims adjudication platform, maintenance and implementation required.
- Experience in Business Quality Assurance processes, required.
- Commitment to expand knowledge of claims, adjudication platform and supportive systems in accordance with initiative/request needs.
- Knowledge of Agile and Kanban, required.
- Strong analytical and critical thinking skills, required.
- Strong decision-making skills, required.
- Strong aptitude for process improvement, required
- Strong communication skills, required
- Ability to supervise, multitask and work independently in a fast-paced environment are essential skills for this position
- If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Nice-to-haves
- Knowledge of Jira board and dashboard management, a plus.
Benefits
- Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
- We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays.
- This role is also anticipated to be eligible to participate in an annual bonus plan.
