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Claims Manager

2 months ago

French Camp, California, United States SAN JOAQUIN COUNTY HEALTH COMMISSION Full time
Job Title: Claims Manager

We are seeking a highly skilled Claims Manager to join our team at SAN JOAQUIN COUNTY HEALTH COMMISSION. As a Claims Manager, you will be responsible for managing projects that require collaboration between various areas of the organization and external entities.

Job Summary

The Claims Manager will support the research and development of innovative or pilot programs, services, products, and ventures. This role will provide strategic and tactical support to the Claims Director to coordinate and drive the development of strategic plans.

Key Responsibilities
  • Supports the research and development of innovative or pilot programs, services, products, and ventures.
  • Provides strategic and tactical support to the Claims Director to coordinate and drive the development of strategic plans.
  • Serves as the key content expert for projects and ensures leadership engagement.
  • Supports development, implementation, and maintenance of best practice methodology, including but not limited to technology, policies, procedures, processes, tools, and standards; ensures their dissemination and understanding amongst the claims department divisions and other impacted stakeholders.
  • Ensures operational preparedness for and compliance with regulatory changes and state audits and supports these activities through interdepartmental collaboration.
  • Socializes understanding of new initiatives and strategies among the claims department and other key stakeholders.
  • Develops, implements, and maintains the appropriate and required data, records, reports, and other documentation.
Requirements
  • Bachelor's degree in business or healthcare administration, or similar disciplines.
  • At least five years progressively responsible healthcare claims experience, which includes all aspects of claims administration.
  • At least five years in using QNXT or similar systems; including all QNXT or similar system modules related to the claims experience.
  • At least three years' experience in using other claims-related applications including Claims Edit Systems (CES) and other integrated pricing systems.
  • At least three years' experience in project management, operations, product development, and healthcare delivery system innovation.
  • At least three years' experience in Managed Medi-Cal/Medicaid and Medicare programs; or
  • The equivalent of experience and education combined.
Preferred Qualifications
  • Completion of a Coding Certification Program (credentialed through AAPC preferred).
What We Offer
  • Competitive salary.
  • Robust and affordable health/dental/vision with choices in providers.
  • Generous paid time off (starting at 3 weeks of PTO, 4 paid floating holidays including employee's birthday, and 9 paid holidays).
  • CalPERS retirement pension program, automatic employer-paid retirements contributions, in addition to voluntary defined contribution plan.
  • Two flexible spending accounts (FSAs).
  • Employer-Paid Term Life and AD&D Insurance.
  • Employer-Paid Disability Insurance.
  • Employer-Paid Life Assistance Program.
  • Health Advocacy.
  • Supplemental medical, legal, identity theft protection.
  • Access to exclusive discount mall.
  • Education and training reimbursement in addition to employer-paid elective learning courses.
  • A chance to work for an organization that is mission-driven – our members and community are at the core of everything we do.
  • A shorter commute – if you're commuting from the Central Valley to the Bay Area.
  • Visibility and variety – you have a chance to work with people at all levels of the organization, and work on diverse projects.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.