Manager, Health Insurance Claims

Location
Norfolk, VA
Posted
Jun 27, 2018
Closes
Aug 20, 2018
Function
Management
Industry
Healthcare
Hours
Full Time
Job Description: Optima Health Community Care is hiring a dynamic and versatile leader for the role of Claims Manager at our Norfolk, Virginia Operations.
Department/Position Overview:


The ideal candidate will possess experience in leading a group of multi-level claims and operations individuals as well as a passion for managing all areas pertaining to the complexities of claims in a goals oriented manner. LTSS experience is preferred.

Division Highlights:

Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission “to improve health everyday.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.


Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Claims Manager is responsible for sustaining and developing departmental policies and procedures, providing oversight to staff responsible for claims processing activities, and ensuring that the organization¿s service, quality, productivity, and financial standards or goals are achieved. Oversee high dollar, complex claims auditing, monitor claims interest, perform detailed claims analyses and compose correspondence and/or detailed reports. Monitor and oversee direct reports to include Team Coordinators and employees. Assist with internal and external audits by thoroughly analyzing all errors and grievances. Create new claims policies or make recommendations to existing policies in the Claims P&P

Education Level
Bachelor's Level Degree

Experience
Required: Related - 3 years

Other
3 years of health plans claims disbursements required

Keywords: managed care, health plan, claims, claims processing, manager, LTSS

Equal Opportunity Employer

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