Claims Lead - Interdepartmental Oversight - SHCN
The Claims Lead - Interdepartmental Oversight and Priority Claims main focus is to track, monitor progress and ensure issue resolution for inter-departments and priority claims through different internal processes from receipt to final disposition. Tracking may include configuration, claims processing, medical claims review, internal audit, final denial / paid date, and notification to provider. High dollar claims are identified by the current medical claims review policy. Priority claims are identified by Network and / or Senior Leadership. This position will assist in ensuring claims turnaround time and accuracy goals are met in regard to high dollar / high priority claims.
Additionally this position may assist the supervisor(s) with daily operations as well as assisting the trainers for training materials / education sessions. In regard to tracking inter-departments and priority claims, this position may provide feedback to the supervisor(s) and trainer through written and verbal documentation / communications regarding claims issues, process improvements and other areas of concern.
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment GÇô while still being valued for your individual strengths GÇô Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
High School Diploma or GED
Some college in business or health care
At least three (3) years claims processing experience in CMS 1500, UB and electronic claims in a managed care environment
At least one (1) year processing claims on the Med/MC processing system
Ability to supervise and lead others
Ability to think analytically and take independent decisions