Manager, Claims Operations

JOB SUMMARY:
This role ensures timely, accurate processing of all aspects of the identification, investigation, and validation processes for organizationally utilized Payment Integrity (Coordination of Benefits or Data Mining) and/or Revenue Integrity solutions. This role monitors, prioritizes and distributes work to assigned team(s); facilitating quality processing of cases according to established policy and procedure as well as client service level agreements (SLA's). The incumbent will work to identify recoveries for assigned clients that meet or exceed forecasts; and partners with senior leadership to execute on short and long term production strategies. In addition to leading a team of investigators and analysts, this individual will also be responsible for the research and development of new solutions and/or concepts and the continual refinement of existing solutions and/or concepts using industry knowledge, data, and expertise.

JOB ROLES AND RESPONSIBILITIES:
1. Ensure Team achieves measured production, quality and growth results, key to the financial success of the department.
2. Manage and own regular communication with Client(s) on all day to day activities.
3. Drive Team, including yourself, to develop new concepts and refine existing solutions to drive revenue growth.
4. Hold Team and self accountable to research and implement critical revenue growth options by staying current on the latest industry trends, policies and guidelines
5. Lead the candidate interview process and provide recommendations to the Director of Operations as well as training new staff and performing quality assurance functions and continuous process improvement.
6. Promote a positive team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals.
7. Select, develop, and evaluate staff to ensure the efficient operation of department.
8. Collaborate, coordinate, and communicate across disciplines and departments.
9. Ensure compliance with HIPAA regulations and requirements.
10. Demonstrate Company's Core Competencies and values held within.
11. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
12. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:
This role works under minimal supervision in the completion of the duties and responsibilities tasked through the position. Work completed within this role may be varied and complex in nature. The incumbent will regularly liaise amongst all levels of the organizational structure (both internally and externally). This is a people management job with authority for all HR actions (hiring, firing, discipline, training, etc.).

COMPENSATION:
The salary range for this position is $85k-$100k. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

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