Manage accounting and financial reporting functions in support of the Finance Division including overseeing the gathering, preparation, analysis, and reconciliation of financial data to ensure compliance with accepted accounting principles and standards.
Participate in projects to improve and/or facilitate claims processing, recovery, and accounting functions.
Manage financial recovery activities including refunds and collections
Manage team leads and staff by efficiently driving work volume to keep high level of utilization and engagement in the group
Resolve complex claims appeal by coordinating with different stakeholders for certain high value claims
Collaborate with Audit and Payment Integrity to sustain a pre-determined level of accuracy and quality
Negotiate Claims ASO performance guarantees, reviews, approvals, and client RFPS in collaboration with Sales organization
Represent Claims Operations on monthly Performance Guarantee Oversight and bi-weekly Sales & Service Operations leadership calls providing status updates, data, reports, analytics, and expertise routinely and on demand.

Bachelor's degree or advanced degree (where required)
8+ years of experience in related field
In lieu of degree, 10+ years of experience in related field
Background in commercial medical claims and recovery operations, with prior experience in a health plan or payer organization
Proven ability to lead, influence, and collaborate across multiple functions and stakeholder groups
Strong analytical skills with the ability to drive change and manage operations – highly preferred
Ability to ensure risks associated with business activities are effectively identified, measured, monitored and controlled within accordance with compliance policies and procedures – highly preferred
Six Sigma or Lean Management training/certifications
preferred

Medical, dental, and vision coverage along with numerous health and wellness programs
Parental leave and support plus adoption and surrogacy assistance
Career development programs and tuition reimbursement for continued education
401k match including an annual company contribution

Claims Manager

Key skills