Manager of Claims - Health Plans - Reliant Staffing Solutions

Permanent, Full-Time Manger of Claims - Health Plans ~ Corvallis, OR

** Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed **

JOB SUMMARY/PURPOSE

• Oversees and manages the Health Plans Claims Department. Responsible for accurate and timely claims processing for all programs.
• 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

• Operates a portfolio of health plan products under several different legal structures: a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries, offering Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans 
• Third-party administrator for self-funded employee health benefit plan. 
• Part of an Integrated Delivery System, strategically and operationally aligned with hospital system's 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

If interested, DM or email resume to cnilson@reliantstaffingsolutions.com

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Christine ~ Reliant Staffing Solutions