Healthcare Claims Manager
Rapidly growing Medicaid-Medicare Health Insurance
Plan
Location: Baltimore MD: Local
Candidates Preferred
About the
opportunity: We are a rapidly growing health plan
currently serving over 350,000 members in over 40 states, in partnership with
over 30,000 physicians. Uniquely focused on providing a variety of Medicare
Advantage and Part D Prescription Drug plans, each of our members is empowered
with the information that they need to tailor the right coverage to fit their
specific healthcare needs, budget and lifestyle. Our Baltimore headquarters
capitalizes on the proximity of the Centers for Medicaid and Medicare Services
(CMS), offering local candidates significant long term career potential. Our
uniquely consumer-driven health plan provides our valued members both rich
choice and exceptional value – which in turn has driven unprecedented demand for
our health plan offerings. Currently we have 1000 employees, over a third of
whom have been hired within the last 18 months!
About the
Position: Because of our sustained growth, we need
another Claims Manager to join our leadership team. Reporting to the
Director of Claims Production, the successful candidate will be a key member of
our Claims management team. Will be responsible for all aspects of claims
payment issue resolution, including supervising claims staff to ensure
appropriate claim outcomes through consistent execution and continuously
improving best practices. This manager will lead and mentor a high performance
team of highly skilled institutional claims specialists. Staying laser focused
on creating high value for the claims payment operations, will operate as a
world class service delivery unit.
Responsibilities: The successful candidate will have
a proven track record of success:
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Providing oversight and managing the
day-to-day workflow and quality results for an Institutional Claims
function, preferably including Medicare claims.
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Leveraging prior claims and management
experience to meet business unit goals, meeting and exceeding claims
department quality audits.
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Using performance management processes to
optimize performance of team, address specific performance issues, provide
development opportunities, and promote effective communication.
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Monitoring individual team member’s
performance, counseling, and ensuring appropriate training needs e.g. to
improve claims evaluation and adjudication results.
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Proactively managing individual assignments,
using staff resources effectively to meet departmental objectives and budget
goals.
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Providing technical direction and ongoing
guidance to claims staff, including planning responsibilities and directs
activities,
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Ensuring compliance with established quality
and production standards, internal company guidelines and expectations, as
well as with legal statutes and policy provisions.
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Ensuring timely, accurate documentation of
claim activity and results
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Leading project efforts to identify, analyze,
and implement efficiencies leading to increased service levels and
productivity.
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Resolving complex service issues in a timely
manner, including analysis of service failures to help determine course of
action.
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Recognizing and analyzing trends across the
claims portfolio at three levels: by adjuster, by unit and by individual
account. Reporting on findings and recommending appropriate action.
Qualifications and Experience: In addition to a
successful track record of experience performing the responsibilities above the
successful candidate will meet the following minimum
Requirements:
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Bachelor's degree and/or a
minimum of three years of experience in the following:
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Health insurance claims
management experience, Medicare experience is a strong plus.
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Experience mediating
solutions to provider and member problems, handling complaints and
minimizing dissatisfaction.
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Demonstrate sensitivity to
the inter-relationship of both people and functions within the department.
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Strong background with
healthcare services and claims, from perspective of 1) insurer, 2) customer
and 3) provider, with Medicare claims experience strongly preferred.
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Extensive knowledge of
Medicare/Medicaid institutional regulations, insurance contracts, applicable
law and adjusting techniques.
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Familiarity with
project management process and productivity tools, including
advanced skills with Microsoft Access and Excel.
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At the appropriate time,
references who can attest to the following “soft skills”:
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Professional attitude and
team player, known to take initiative and work independently
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Superior verbal /written
communication skills, including listening and conflict resolution skills.
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Demonstrated leadership, both
coaching and mentoring individual staff and teams
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Known for applying sound
judgment, making decisions, and solving problems.
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Respected for effective
organization, negotiation and implementation/influencing skills
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Ability to affectively lead,
adapt and respond in a complex, fast-paced environment.
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Multiple task oriented, i.e.
flexible and able to adjust to rapidly changing priorities
Target
compensation package includes a competitive base
salary in the high seventies to low eighties, performance-driven
bonus opportunity of 10% and (of course!) a comprehensive benefits package.
Actual compensation package will depend on 1) relevant experience, 2)
current / most recent compensation history, and 3) performance once on board.
To Explore
Further: Please specify “Medicare Claims
Manager-MCOL” when forwarding your resume, target salary range (in strictest
confidence) to Ann@BolandGroup.com.
Candidates who provide responses to the following questions when applying will
receive most immediate consideration:
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Your compensation history (base and bonus, as far back
as your highest W-2)
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Location: How long has you been
living and working in the Washington DC metro area?
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Timing and motivation: please
explain the reason for your interest in this role?
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Stability:
If you have worked for any company for less than two years, please explain?
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Work status: Are you a U.S.
Citizen and are you eligible / do you possess a security clearance?
Referrals:
We are happy to acknowledge / recognize referrals as appropriate. Please advise
us, or ask the individual to refer back to you, should you forward this position
overview? Should you wish to refer someone in confidence, please advise us
accordingly when forwarding their contact information.
About the
Boland Group: Founded by a former “big five”
management consulting partner, the Boland Group is a performance-driven retained
executive search consulting firm. We specialize in recruiting for firms in
information intensive industries.
Confidentiality: As a member of the premier retained
global executive search association (IACPR), we adhere to the highest standards
in the industry. Any information provided to us by current or prospective
clients and candidates is considered to be strictly confidential; no information
will be shared without your explicit, prior consent.
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