Claims Manager

UHS•Reno, NV

13d

About The Position

Prominence Health is a value-based care organization that connects affiliated health systems and independent providers through trusted, collaborative partnerships. It supports populations and providers across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships, with the goal of improving health outcomes, controlling costs, and enhancing the patient experience. The Claims Manager manages claims for Commercial, ASO, and Medicare products and provides staff training in accordance with contracts, rules, regulations, and company policies and procedures. The role oversees and coordinates interactions with various health plan departments, coordinates production across health plan products to ensure claims are paid promptly, and resolves questions about claim payments and benefits. This position reports to the Director of Operations.

Requirements

Bachelor’s degree or equivalent experience.
At least five years of experience in a health plan environment.
At least five years of experience in Medicare/Medicaid claims processing.
At least two years of previous supervisory experience.
At least two years of experience with advanced computer systems.
Ability to communicate effectively in English, verbally and in writing.
Excellent skills in Microsoft Excel, Word, and Access.
Ability to plan, organize, and maintain priorities and schedules, and ensure deadlines are met.
Excellent verbal and written communication, organizational, and interpersonal skills.
Ability to interpret and apply established policies and procedures for all health plan products.
High personal motivation, ability to work independently, and sound professional judgment and behavior.
Evidence of team collaboration, creativity, integrity, self-confidence, and commitment to quality service.
Ability to maintain confidentiality.
Ability to work with diverse individuals and establish strong cooperative working relationships.
Ability to identify trends and potential problems, and recommend corrective action or program and procedural development.

Responsibilities

Manage claims for Commercial, ASO, and Medicare products.
Train staff in accordance with contracts, rules, regulations, and company policies and procedures.
Oversee and coordinate interactions with various health plan departments.
Coordinate production of all health plan products to ensure claims are paid in a timely manner.
Resolve questions regarding claim payments and benefits.