Job Description SEE how you can make a difference Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision. Versant Health provides vision care to 37 million members nationwide To ensure your continued success we provide opportunities for advancement and development. Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family. Scope and Purpose of Position Responsible for the management oversight, processing, reconciliation and audit controls for claims adjudication. Ensure government regulations and contractual deadlines and commitments are satisfied. Essential Functions Supervise the Claims team to include selection, training and development, coaching, counseling and performance management. Establish and successfully communicate Claims department goals and objectives together with individual goals and expectations; perform associate evaluations and provide coaching as appropriate Implement processes to ensure timely and accurate processing of claims. Manage claims process including reconciling and auditing of claims submitted Provide statistical analysis of claims flow and production results. Provide client service and technical support, including data analysis, troubleshooting and issue resolution. Identify and develop enhancements to the claims process, including scanning, vertexing, workflows, system software, etc. Develop and manage corrective action and quality improvement plans. Determine root cause concerns and develop applicable corrective actions. Ensure full compliance for all accreditations and governmental ratings. Oversee specialty accounts management. Special projects, as assigned or necessary. Maintain departmental documentation, internal and external certifications Education & Experience Preferred bachelor's degree in related field or equivalent combination or experience and education Three (3) plus years of related experience Three (3) plus years managerial experience, including demonstrated experience in managing teams, setting goals/expectations, managing to timeline driven outcomes, and implementation of sustainable strategic solutions Three or more years of experience in the management of claims processing Thorough knowledge of health care insurance as might be shown by three to five years in an insurance company Direct client interface experience Competencies Sound administrative skills. Developed management skills - principles and people Proven ability to identify and resolve potential challenges through analytical and logical means and effectively communicate recommendations for resolution5 years minimum management experience in a claims department Excellent PC and communications skills Ability to read and interpret detailed reports Ability to evaluate and document business requirements Strong knowledge of claims workflows and processes Excellent organizational skills Strong delegation skills Professional written and verbal communication and interpersonal skills Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or Associates of the organization. General mathematical skills to include basic adding, subtracting, multiplication and division Ability to think logically in following procedures and instructions General problem solving abilities Exhibit sound and accurate judgment and demonstrate accuracy and thoroughness Strong organizational skills Ability to analyze and interpret data Work under stress with interruptions and deadlines Strong customer focus Strong attention to detail Ability to prioritize detailed tasks with minimal input to accomplish daily and long-term goals Ability to work onsite and participate in interactive onsite meetings on a regular and predictable basis. Ability to initiate immediate interaction, coordination and collaboration with team members, clients, customers etc. HIPAA & Security Requirements All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program. We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process. We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, age, sex (including pregnancy), sexual orientation, gender identity or expression (including transgender status), national origin, ancestry, status as a protected veteran or disabled veteran, physical or mental disability or history of disability, genetic information, marital status, or any and all other categories protected by under applicable Federal, state or local law. This policy extends to all associates and to all aspects of the employment relationship. Any associate who violates this policy will be subject to disciplinary action up to and including termination. Company Description Versant Health bringing you Davis Vision and Superior Vision is a leading provider of vision and eye health solutions. We offer a full spectrum of services in the vision care marketplace. Our mission is very real to our members: we help them enjoy the wonders of sight through healthy eyes and vision. What you do as a Versant Health Associate matters. 37 million Americans count on us to provide access to annual eye exams and corrective eyewear. We are here to change the face of vision care, and together we will make this happen.