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Description
Logistics:
- Direct and supervise claims/documents processing and support team associates to ensure claims/documents are processed in a timely and efficient manner to maintain contract compliance standards. Prepare and analyze reports of pending and processed documents, claims, adjustments and reprocesses, and quality audits of claims/documents that measure level of performance of the team. Administer and oversee quality control procedures and ensure compliance of all corporate and contract required guidelines. Select and maintain a well-trained staff. Identify potential education and system issues.
- Establish and maintain a high level of customer service with all internal and external customers. Direct and supervise the customer service associates to ensure that all correspondence and telephone inquiries are processed in a timely and efficient manner to maintain contract compliance standards. Select and maintain a well-trained staff. Identify potential education and system issues.
- Participate as project leader on policy changes, quality improvements initiatives and system change efforts, while ensuring corporate, contractor, and department policies and procedures are administered timely, consistently, and accurately. Identify system errors and process/quality improvement opportunities, initiate work requests, and serve as the customer project lead to ensure accurate implementation.
- Assist in budget preparation and monitor expenses related to the budget.
- Bachelor's degree
- 3 years of job-related work experience, including either 1 year of supervisory experience OR 1-year equivalent military experience in grade E4 or above.
- Strong management, organization, communication, decision-making, and analytical skills.
- Excellent customer service skills.
- Strong presentation skills and basic business math proficiency.
- Knowledge of applicable laws and regulations pertaining to business unit operations.
- Microsoft Office.
- TRICARE knowledge/experience
- Government Program Experience (Medicare, Medicaid, State Programs, etic)
- Experience leading Claims and/or Customer Service teams.
- Experience supporting contract startup and/or transitions.
- Experience supporting the implementation of system changes.
- Experience performing claims processing and/or customer service functions.
- Experience with basic concept of ISO.
- Preferred Work Experience: 3 years-of related health or managed care industry work experience. 1 year-of management experience OR 1 year of equivalent military experience in grade E4 or above.
- Ability to use complex mathematical calculations.
- Knowledge of mathematical or statistical concepts.
- Proficient in database software.
- Subsidized health plans, dental and vision coverage
- 401K retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies, theaters, zoos, theme parks and more
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.