Claims Operations Director

Capital Health Plan • Tallahassee, FL

10d

About The Position

Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries. Directs the activities related to billing and reconciliation of premium payment by employers and individuals. Directs the activities of contract administration function in appropriate and timely software updates, code/fee configurations, and overall provider and contract administration. Directs the activities of payment integrity staff in root cause analysis of claims related issues, third party vendor oversight, and claims related risk adjustment processes. Supports the implementation of software enhancements.

Requirements

• Bachelor's degree (BA/BS) from four-year college or university; or one to two years' related experience and/or training; or equivalent combination of education and experience.

Nice To Haves

• Ten years related experience preferred.

Responsibilities

• Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries.
• Directs the activities related to billing and reconciliation of premium payment by employers and individuals.
• Directs the activities of contract administration function in appropriate and timely software updates, code/fee configurations, and overall provider and contract administration.
• Directs the activities of payment integrity staff in root cause analysis of claims related issues, third party vendor oversight, and claims related risk adjustment processes.
• Supports the implementation of software enhancements.

What This Job Offers

• Career Level: Director