Director Claims Administration

Corewell Health • Grand Rapids, MI

3d • Onsite

About The Position

The Director of Claims Administration is responsible for the accurate, timely and efficient adjudication and payment of claims for all product lines at Priority Health. The leader is accountable for claim inventory, claim speed to process, claim auto adjudication rate, claim examiner quality scores, coordination of benefits savings, and third party liability savings.

Requirements

• Bachelor's Degree or equivalent education and experience
• 10 years of relevant experience
• Prior management experience
• 2 years of relevant experience
• Prior claims administration management experience

Nice To Haves

• Health care plan claims experience strongly preferred.

Responsibilities

• Lead and develop a high performing claims adjudication team.
• Assure proper staffing levels.
• Implement goals setting, monitoring and achieving service-levels, medical trend management savings, and unit costs.
• Ensure functions to meet or exceed corporate standards for accuracy and timeliness of claim payment.
• Foster and maintain relationships with other departments to ensure that claims processes and procedures efficiently support other departments, products and overall customer service.
• Service on corporate committees as directed.
• Initiate process improvement and cost-saving measures.
• Foster an environment that allows for continuous improvement.
• Develop multi-year roadmaps and meet targets for unit costs, service levels, coaching and development, and other goals as developed.
• Effectively communicate issues and concerns through verbal and written communications.
• Effectively communicate operational issues and concerns to leadership.
• Ensure compliance with state and federal rules and regulations such as HIPAA, Department of Labor, ERISA, Michigan HMO Legislation, Medicaid, MiChild and Medicare.

Benefits

• Comprehensive benefits package to meet your financial, health, and work/life balance goals.
• On-demand pay program powered by Payactiv
• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
• Optional identity theft protection, home and auto insurance
• Traditional and Roth retirement options with service contribution and match savings

What This Job Offers

• Job Type: Full-time
• Career Level: Director