Manager III Financial Ops Dept

Elevance Health - Manchester, NH

Full-time - Manager

Manchester, NH

Insurance Carriers and Related Activities

About the position

The Manager III Financial Ops Dept is responsible for coordinating, directing, and managing several units of varying complexity that has multi-state or multi-functional impact within Cost Containment. Manages the daily operations of a datamining team focused on identifying and recovering overpaid medical claims and maintaining and strengthening the relationship with datamining vendors. The areas of focus for the team this role will be leading include but are not limited to: claim coding and billing, medical terminology, claims payment and recovery process, system configuration, and claims auditing.

Responsibilities

• Assists in the development and implementation of vision, strategies, and tactics to maximize the departments effectiveness while minimizing costs.
• Reviews statistical data of various systems in order to verify accuracy and timely processing.
• Ensures internal controls are appropriate and develops policies and procedures and ensures compliance with government regulations.
• Provides counsel to senior management.
• Works with other areas for solutions to complex problems and participates in critical interactions with both internal and external customers.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Requirements

• Requires minimum of 7 years experience with operations, financial reporting and analysis, audit guidelines, budgeting and multi-state operations and processes.
• Minimum of 5 years management experience.
• Any combination of education and experience which would provide an equivalent background.

Nice-to-haves

• Knowledge of claims processing, reimbursement policies and provider contracting.
• Ability to lead a high performing team by mentoring and developing associates.
• Strong understanding of healthcare industry process.
• Commercial experience.
• Cost Containment/payment integrity experience.
• Experience recovering overpaid Commercial claims.
• Vendor management experience.
• Experience with complex business environments including multiple entity and highly automated situations.
• PMP certification.

Benefits

• Merit increases.
• Paid holidays.
• Paid Time Off.
• Incentive bonus programs.
• Medical, dental, vision benefits.
• Short and long term disability benefits.
• 401(k) + match.
• Stock purchase plan.
• Life insurance.
• Wellness programs.
• Financial education resources.