Manager of Claims

2 weeks ago

Corvallis, United States Sigma Inc Full time
267099 - Manager of Claims - Health Plans - Corvallis, OR - Full Time Direct Hire

Sigma Healthcare team is looking for a Manager of Claims - Health Plans to work onsite at our client's facility in Corvallis, OR.

Shift : Days, Full Time.

Job Summary/Purpose:
  • Oversees and manages the Health Plans Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Health Plans. Provides oversight to staff and ensures that the organization's performance expectations, financial standards, and goals are achieved. Enhances department bench strength by hiring, coaching and mentoring direct reports. Responsible for the completion and success of all internal and external claims audits. Analyzes claims data and ensures compliance requirements are met.
Department Description:
  •  Operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries;Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for our Health Services' self-funded employee health benefit plan.
  • As part of an Integrated Delivery System, our Health Plans is strategically and operationally aligned with  Health Services' mission of Building Healthier Communities Together.
Experience/Education/Qualifications:
  • Bachelor's degree in healthcare or a related field, or equivalent direct claims experience required.
  • Three (3) years management experience in a health plan claims department required.
  • Medicare and/or Medicaid experience preferred.
  • Collecting, analyzing and displaying statistical reports by computerized technology.
  • Basic medical terminology.
Knowledge/Skills/Abilities:
  • Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
  • Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
  • Critical thinking - Identifies complex problems.Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
  • Communication and team building - Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.

Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed. We need a candidate with strong management experience. 

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