The Corporate Director Employee Health Plan Claims
provides high level oversight of the entire Claims process from initial claim submission to final payment of all claims for all Employee Health Plans. The Corporate Director Employee Health Plan Claims will interact with all aspects of the Health Plan Team including Utilization Review and Customer Service. In addition, there will be liaison with senior Prime Healthcare Management which includes presentation of formal analyses of plan payments as well as team productivity. Additional info:
- This position requires a comprehensive understanding of this process, primarily for a self-insured Exclusive Provider Organization, but also for PPO, ACA and Point of Service Plans.
- The Director will initially oversee a team of five who oversee the current TPA. In the near future, this team will expand and require development of optimal processes and procedures to pay both facility and professional claims.
- This position will require the presentation of formal analyses of plan payments as well as team productivity.
- While the position is based full-time at Prime Corporate Headquarters in Ontario, CA, some travel may be required.
#LI-CC1QualificationsRequired qualifications:A minimum of 5 years’ experience as Director of Claims for a Health Plan, a large IPA or a TPAMinimum BA/BS degreeStrong knowledge of medical coding (ICD-10, HCPCs/CPT, etc.)Extensive knowledge of all aspects of Medical Claims both Facility and ProfessionalCertified Professional Coding Certification, AIC, ARM or equivalentExcellent negotiation, analytic and organizational skillsStrong management, oral and written communication skillsStrong computer skills incl. MS Office skills Preferred qualifications:MBA in Healthcare or equivalent degreeAdvanced computer and MS Office skillsFamiliarity with multiple Business Intelligence software systems and daily usage of at least oneHands on experience with TPA
We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf.