Manager of Claims Health Plans

Full Time Manager of Claims Health Plans for a Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed. We need a candidate with strong management experience.

Shift: Days.

W2 Benefits.

Minimum Years of Experience: 3

JOB SUMMARY/PURPOSE

Oversees and manages the Health Plans Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Health Plans. 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: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; also the third-party administrator for Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Health Plans is strategically and operationally aligned with Health Services’ 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

Job Type: Full-time

Pay: $73,000.00 - $88,000.00 per year

Schedule:

• 8 hour shift
• Day shift

Work setting:

• Hybrid work

Education:

• Bachelor's (Required)

Experience:

• Management: 3 years (Required)
• health plan claims department management: 3 years (Required)
• Collecting, analyzing and displaying statistical reports: 1 year (Required)
• Basic medical terminology: 1 year (Required)
• 6. Medicare and/or Medicaid: 1 year (Required)

Ability to Relocate:

• Corvallis, OR 97330: Relocate before starting work (Required)

Work Location: Hybrid remote in Corvallis, OR 97330