Operations Claims Manager 3 – Change Healthcare – Florida

Operations Claims Manager 3

Change Healthcare is a leading healthcare technology company with a mission to inspire a better healthcare system. We deliver innovative solutions to patients, hospitals, and insurance companies to improve clinical decision making, simplify financial processes, and enable better patient experiences to improve lives and support healthier communities.

Operations Claims Manager

We are looking for an Operations Claims Manager to support to join our team. This position providers managerial oversight of medical claims processing and member/provider contact center. This role will be responsible for driving results, maintaining client relationships, foster team development, provider guidance to supervisory staff, and supporting the goal and objectives of internal and external clients. The position would report to the Senior Director of Operations and work with other leaders within the organization to provide delivery services. The claims team processes commercial and Medicare professional and institutional claims. The contact center receives inbound inquiries related to claims, authorizations, eligibility, and benefits. This role has a supervisory staff to support day-to-day operations.

What will be my duties and responsibilities in this job?

• Responsible for overseeing day-to-day administrative, financial, personnel and procedural activities for product and/or service operations functions in a non-manufacturing environment for a company site(s).
• Leads site efforts to develop and improve through efficient and effective integrated processes, implementing common management processes/services to leverage organization resources.
• Directs operations review of cost and service structures, productivity measures and delivery methods to achieve planned targets.
• Typically acts as a point of contact or gatekeeper between management and staff. May select, develop, and evaluate personnel to ensure the efficient operation of the function/unit.
• Responsibilities specifically include the management of the Claims Services Department which reviews and adjudicates all claims submitted by members or providers; Medicare and Medicaid as well as other lines of business as may be applicable.
• In addition, oversee the Call Center Operations, which include the management of personnel, associate workflows, service level agreements, and continuous quality improvement.

What are the requirements?

• At a minimum, 2+ years of related experience and demonstrated leadership skills.
• 4+ years related experience, training or equivalent combination of education and experience.
• Advanced MS Applications skills including MS Word, Excel, Access, Outlook and PowerPoint. (i.e. MS Excel – constructing pivot tables, data analysis, and trending)

What critical skills are needed for you to consider someone for this position?

• Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community.
• Ability to effectively present information to top management, public groups, and/or boards of directors. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Knowledge of general medical terminology and in-depth knowledge of Medicare/Medicaid process, rules, regulations, and procedures.
• Ability to audit claims accurately. Ability to maintain documents and files with accuracy and completeness. Ability to handle sensitive information in a confidential and professional manner. Ability to interpret contracts as it relates to claims and payment guidelines.
• Ability to successfully respond to inquiries or complaints from internal or external customers including excellent research, troubleshooting, and problem-solving skills as well as the ability to devise effective solutions and provide professional, timely, and thorough responses.
• Ability to follow written and oral directions with minimal supervision. Ability to manage and lead subordinates. Self-motivated with strong organization and decision-making skills, including the ability to prioritize multiple tasks and perform them both accurately and timely.
• Ability to work effectively with others including the ability to exercise tact, diplomacy, and good judgment. Strong written and verbal communication skills in order to communicate in clear, concise terms to internal and external customers.

What other skills/experience would be helpful to have?

• Bachelor’s Degree in Business preferred
• In-depth knowledge of the Medicare/Medicaid process, rules, regulations, and procedures helpful

How much should I expect to travel?

• <10% – occasional travel to Change Healthcare offices or meetings may be required
• Employees in roles that require travel will need to be able to qualify for a company credit card or be able to use their own personal credit card for travel expenses and submit for reimbursement.

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Diversity and Inclusion:

• At Change Healthcare, we include all. We celebrate diversity and inclusivity, respect each other and value our unique experiences. By being our authentic selves, we bring different perspectives into our work and relationships.
• Business Resource Groups (BRGs) play a central role in advancing diversity and inclusion at Change Healthcare. They deepen our understanding of different cultures, people, and experiences, and help foster an inclusive workplace. Change offers eight (8) BRGs. Learn more at https://careers.changehealthcare.com/diversity

Feeling Inspired? Ready to #MakeAChange? Apply today!

COVID Vaccination Requirements

We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and, when job-related and consistent with business necessity, we may require periodic testing for certain roles. Some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance.

Equal Opportunity/Affirmative Action Statement

Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.eeoc.gov/employers/eeo-law-poster and the supplemental information at https://www.dol.gov/ofccp/regs/compliance/posters/pdf/OFCCP_EEO_Supplement_Final_JRF_QA_508c.pdf.

If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to [email protected] with “Applicant requesting reasonable accommodation” as the subject. Resumes or CVs submitted to this email box will not be accepted.

Click here https://www.dol.gov/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf to view our pay transparency nondiscrimination policy.

California (US) Residents: By submitting an application to Change Healthcare for consideration of any employment opportunity, you acknowledge that you have read and understood Change Healthcare’s Privacy Notice to California Job Applicants Regarding the Collection of Personal Information.

Change Healthcare maintains a drug free workplace and conducts pre-employment drug-testing, where applicable, in accordance with federal, state and local laws.