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Claims Manager

Company: WPS Health Solutions
Location: Hampton
Posted on: September 13, 2018

Job Description:

Who We AreWe are a leading not-for-profit health insurer in Wisconsin, and our services have grown to reach active-duty and retired military personnel, seniors, and families in Wisconsin, across the U.S., and around the world. Learn more!WPS receives World's Most Ethical Company Award for 9th Year in a Row - 2018 Most Ethical Companies AnnouncementAt Our CoreWPS Health Solutions has earned a reputation as a leader in the insurance and benefits administration industry through our commitment to excellence and high-quality service. Our corporate values reflect the core of who we are and how we conduct business every day. Customer FocusedI recognize how my actions impact internal and external customers by being responsible for the customer experience. I look beyond the immediate issue to recognize and solve the problem. Individual ResponsibilityI own my actions. I am accountable and dedicated to achieving the best results for WPS Health Solutions and our customers. I embrace my role in helping the company achieve a high-performance workplace. Mutual RespectI lead by example and act ethically, honestly and am trustworthy. I show appreciation for others by giving and taking constructive feedback and encouragement. Driven and PassionateI approach my work with enthusiasm, and personal commitment to the success of our business. I keep the importance of the work we do for our customers alive in my attitude and interactions with others, and demonstrate pride in the worthiness of our purpose. Position SummaryThe Claims Manager manages claims processing functions and operations to accomplish timely, accurate, consistent, and cost-effective performance. You are responsible for claim development, eligibility, and jurisdiction resolution, as well as other health insurance, duplicate claims, and manual fee processing. You will monitor exempt supervisory staff and unit performance to support achievement of company strategic goals.In this role you will:Functional Management (100%)

  • Provide support/direction for supervisory staff responsible for MVH Claims Resolution, TRICARE Provider Certification Unit, TRICARE Encounter Data System, and Third Party Liability units.
  • Direct staff in achievement of deadlines, assignments, and commitments to ensure multiple contract performance standards for claims processing are met.
  • Review and analyze workflow/production for optimal results and attainment of contract standards.
  • Serve as technical point of contact for development/coordination of IS requirements/design for claims processing system programming changes. Monitor impact of implementation.
  • Sponsor projects for programming changes that impact areas of responsibility. Monitor schedule and budget, resolve project issues, recommend ways to minimize complexity and add value, approve phase gateways, and provide post project input.
  • Ensure an inclusive and unbiased work environment is created and sustained.
  • Oversee selection, training, and evaluation of employees, guiding and approving discipline as necessary and recommend coaching and developmental opportunities.
  • Achieve cost-effective claims processing through staff performance, system, and process efficiencies. Monitor, improve, and simplify processes for timely and quality performance.
  • Establish, review, and revise claims processing workflow, inventory, and claims aging control procedures.
  • Review, revise, and approve claims processing procedures/guidelines; ensure they comply with corporate and government policies, contracts, and applicable laws and regulations.
  • Analyze impact of government directed changes or draft changes as primary contact for claims processing. Implement changes as needed.
  • Manage contract phase in/out functions including staffing, claims processing, and records management.
  • Serve as technical and operational claims processing point of contact for any external visitors including prime contractors, governmental, or external auditing agencies.
  • Prepare detailed reports and supporting information regarding staffing, production, training, space/equipment, disciplinary actions, or budget requirements.
  • Review and analyze staffing levels and need, developing corrective actions if needed. Allocate resources across work types to ensure performance meets or exceeds requirements.
  • Prepare budget for claims processing areas. Monitor expenses compared to budget and establish corrective actions to effectively use company resources and minimize waste.
  • Prepare and present claims processing contract standards for governmental customers.
  • Provide technical support pertaining to claims processing for contract proposals, review and revise draft text.You should have:
    • Bachelor's degree in Business or Healthcare Administration or related field with coursework in insurance and medical terminology; OR equivalent post high school education and/or work-related experience
    • 5 or more years relevant experience to include 3 or more years in a supervisory/admin role using Management/Human Relations skillsetsIn addition, we prefer:
      • Experience with government offices, contracts, regulations, and policies Stay connected: Join ourTalent Community! FOLLOW US!FacebookTwitterLinkedIn

        Keywords: WPS Health Solutions, Hampton , Claims Manager, Executive , Hampton, Virginia

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