Careers At HGS

Healthcare Claims Operations Manager

Job Code : HGS/601
El Paso, EL PASO, TX

Job Description

Purpose:

The Claims Operations Manager is responsible for the overall business culture and operation of the site and the development, guidance and direction of claims operations staff. The incumbent is an experienced and well rounded “hands on” leader with a focus on driving operational performance, facility management, P&L and continuous improvement initiatives. The Claims Operations Manager will have a team of 5 or more direct reports and will be responsible for up to 200 claims operations employees.

Reports to:

This position reports to the Senior Director, Operations or Vice President, Operations.

Responsibilities:

 

  • Direct day to day operations of the claims department and ensure that claims are processed within client and company guidelines
  • Empower the claims leadership team and support the department and ensure quality claims metrics and service level agreements are met
  • Collaborate with executive leadership from cross functional departments to ensure efficiency and proper prioritization of the claims adjudication process
  • Provide regular feedback, support and leadership regarding department level performance in critical areas such as P&L, KPI, company policy and procedure adherence, and client and employee satisfaction
  • Proactively create, implement and lead department improvement efforts that produce successful results in the aforementioned areas
  • Meet profitability goals in the profit center environment
  • Establish and communicate client and internal strategies and key performance indicators to the healthcare vertical’s management team
  • Serve as an effective business partner to multi-site clients working in conjunction with peers to achieve mutual goals
  • Actively participate in the site’s Occupational Health and Safety and Employee Engagement Committees
  • Participate in weekly corporate level senior leadership meetings
  • Enhance department level bench strength by hiring, coaching and mentoring direct reports; providing career development and professional growth
  • Be an active member of the community and be able to act as a role model within the company
  • Special projects as assigned

The above statements describe the general nature and level of work being performed. This is not intended to be an exhaustive list of all responsibilities and duties required.


Requirements

  • The qualified candidate will possess a bachelor’s degree or equivalent combination of education and experience
  • A minimum of 5 years of progressive responsibility overseeing and developing claims operations preferably in a managed care and or Medicaid setting
  • A strong understanding of Contact Center operations and Contact Center solutions
  • Excellent leadership and interpersonal skills
  • Extensive experience with all Windows platforms, Microsoft Office, internet, etc.
  • Able to work in a 24 hour a day, 365 days per year environment
  • Strong organizational, analytical, leadership, interpersonal and time management skills
  • Flexibility, versatility and proven ability to lead change
  • Strong fiscal management skills in a P&L environment
  • Excellent verbal and written communication skills
  • Strong facilitation and presentation skills
  • Strong project management and planning skills in order to successfully manage multiple projects simultaneously
  • Strong knowledge and experience in complex people management
  • Demonstrated leadership over multi-functional departments to include IT, Telephony, Facilities, Training, Recruiting and HR
  • Minimal amount of travel required
  • Clear criminal record check required

 


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