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OR - Manager of Claims Health Plans - Corvallis
4 months ago
Job Description:
Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed. We need a candidate with strong management experience.
JOB SUMMARY/PURPOSE
Oversees and manages the Samaritan Health Plans Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Samaritan 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
Samaritan Health Plans (SHP) 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; Samaritan 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 Samaritan Health Services' self-funded employee health benefit plan. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan 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.
Experience or training in the following required:
Collecting, analyzing and displaying statistical reports by computerized technology.
Basic medical terminology.
Medicare and/or Medicaid experience preferred.
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
Position Urgency:
Normal
Shifts:
Days, Full Time
State License Details:
Not Needed
Minimum Years of Experience:
3
Specialty Type:
Clerical
Sub Specialty:
All Clerical
Bilingual:
No
Holiday Coverage Required:
No
