Claims Manager

Company Name:
Corizon
The Claims Manager is responsible for the coordination of the claims process in collaboration with the Claims Supervisors. In addition this position will review and analyze processes, client needs and submit proposed alternatives to the Director. Claims Manager will also manage all system configuration and reporting.
Manage system configuration, unit testing and audit of contract entry
Define and develop financial models and tools including cost benefit analysis, utilization models and performance reports
Maintain detailed knowledge of all data bases and subsystems ensuring that best practices are used for all configurations
Provide guidance regarding implementation processes and procedures compatible with system functionality and client requirements
Monitor and manage TPA claim processing and reporting
Review new employee training material to ensure workflow requirements and processes are appropriately reflected and communicated
Assist, coordinate, monitor and document system process improvement testing
Compose formal claim communications and documentation including but not limited to workflow diagrams, policies and procedures.
Supervise an mentor staff responsible for benefit, client contract and provider set-up and reporting
Produce monthly reporting package
Active participant in project planning, staff and team meetings.
Special projects and other duties assigned by management.
Portray and disseminate a positive attitude.
Bachelors Degree in related field from an accredited college or university or equivalent
QNXT or FACETS configuration experience
High level of experience with various software programs, such as MS Office and Visio
SQL experience
Ability to document and communicate claims system gaps, business processes and recommendations
Intimate knowledge of CMS policies and methodology
Ability to effectively prioritize and execute tasks in a deadline driven environment
Ability to travel
cor1
Date: 2014-03-21
Country: US
State: TN
City: Brentwood

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