Sample Job Description for Provider Claims Process and Controls Manager
Job Description Management
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Provider Claims Process and Controls Manager Job Description Sample
Manages and implements corporate policy and process for medical provider and other reimbursements.
EDUCATION/DEGREE
Bachelor's Degree
REPORTS TO
Head of a Unit/Department
Job Responsibilities for Provider Claims Process and Controls Manager
Ensures that all claims are reviewed, settled, and processed in compliance with and according to contract provisions and regulatory requirements. Evaluates and develops policies and provider reimbursement guidelines to effectively manage and control medical claims cost.
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Job Title
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Job Description |
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1
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Fleet Manager - Trucking & Transportation
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The Fleet Manager - Trucking & Transportation oversees DOT compliance and reporting as it relates to the fleet. Manages the operation and maintenance of the organization's motor vehicles. Being a Fleet Manager - Trucking & Transportation manages fleet department budgets. Develops and implements vehicle and equipment preventive maintenance programs. In addition, Fleet Manager - Trucking & Transportation develops and maintains outside vendor and service provider relationships. May require an associate's degree. Typically reports to a head of a unit/department. The Fleet Manager - Trucking & Transportation typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. Working as a Fleet Manager - Trucking & Transportation typically requires 3+ years of managerial experience.
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2
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Medical Administrative Assistant
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The Medical Administrative Assistant performs various secretarial and clerical duties, such as typing reports and correspondence, transcribing written notes, maintaining records and files, answering phones, and arranging clinician schedules. Provides secretarial support to clinical staff. Being a Medical Administrative Assistant requires knowledge of medical terms and vocabulary. May be responsible for entering clinician charges into medical billing system. In addition, Medical Administrative Assistant requires a high school diploma or its equivalent. Typically reports to a supervisor or manager. Being a Medical Administrative Assistant works under moderate supervision. Gains or has attained full proficiency in a specific area of discipline. Working as a Medical Administrative Assistant typically requires 1-3 years of related experience, or may need 0 years of experience with additional specialized training and/or certification.
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3
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Big Data Analytics Manager
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The Big Data Analytics Manager oversees the interpretation of results from multiple sources using a variety of techniques, ranging from simple data aggregation via statistical analysis to complex data mining. Manages the daily activities of the team responsible for identifying business trends and problems through big data analysis. Being a Big Data Analytics Manager may require extensive knowledge of big data tools like Hadoop, Hbase, Hive, Zookeeper, etc. Requires a bachelor's degree in related area. Manages the design and implementation of big data solutions for the organization. In addition, Big Data Analytics Manager typically reports to senior management. The Big Data Analytics Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Working as a Big Data Analytics Manager typically requires 5 years experience in the related area as an individual contributor. 1 - 3 years supervisory experience may be required. Extensive knowledge of the function and department processes.
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4
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Policy Change Operations Director
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The Policy Change Operations Director designs and implements procedures used for expediting policy changes and the calculations used to determine associated costs. Manages all aspects of insurance policy changes according to company guidelines. Being a Policy Change Operations Director requires a bachelor's degree. Develops, implements, and communicates policies and practices concerning policy changes and related costs. In addition, Policy Change Operations Director typically reports to top management. The Policy Change Operations Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. Working as a Policy Change Operations Director typically requires 5+ years of managerial experience.
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5
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Policy Change Operations Supervisor
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The Policy Change Operations Supervisor determines action on changes for which a policyholder has applied, but which are not covered by policy provisions, and computes costs or allowances for policy changes. Supervises a group of insurance policy change technicians to ensure that policy changes and requests are carried out according to established guidelines. Being a Policy Change Operations Supervisor does not have underwriting approval. Contacts policy owners and field agents with pertinent information that may affect a policy change. In addition, Policy Change Operations Supervisor requires a bachelor's degree. Typically reports to a manager or head of a unit/department. The Policy Change Operations Supervisor supervises a group of primarily para-professional level staffs. May also be a level above a supervisor within high volume administrative/ production environments. Makes day-to-day decisions within or for a group/small department. Has some authority for personnel actions. Working as a Policy Change Operations Supervisor typically requires 3-5 years experience in the related area as an individual contributor. Thorough knowledge of functional area and department processes.
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Skills
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Proficiency Level |
| Budgeting |
Level 2
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| Planning and Organizing |
Level 3
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| Judgment and Decision Making |
Level 3
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