Leader, Claims Processing- Alliance Partners
Leader will provide direct oversight to the Cigna, Level Funding, and data entry teams including all aspects of associated vendor inventory management and direct support to those partnerships. Responsibilities will include ensuring that all activity is consistent with company policies, procedures, and contractual or statutory guidelines, as well as preparation of materials for vendor oversight and executive review. Participation in vendor meetings and managing operational processes with vendor partners. Leader will also assist the Claims leadership team in forging process improvements in claims experience, including first pass, automation, and member or provider experience enhancements.
Leader will also support and mentor staff to build a highly skilled team. Leader will provide oversight and direction to staff including the duties of goal setting, performance evaluations, managing system time and attendance, and completing the disciplinary action process, if applicable.
The Leader will also lead Operations projects and be responsible for implementation of assigned projects, and other job duties as assigned.
Bachelors degree required, or equivalent experience
2 years Claims experience. 1-year direct vendor oversight experience preferred.
Independent Adjusters License required( if not certified when hired or transferred into position, license must be obtained within a year, or in the next IAL training class.)
- Familiar with ICD-10, CPT, HCPCS and Revenue codes
- Strong commitment to customer service and understanding and responding to customer needs within specific timeframes
- Strong problem-solving skills and demonstrated ability to follow through on issues to resolution
- Strong verbal and written communication skills
- Excellent time management skills
- Ability to work independently as well as be an effective team member
- Ability to prioritize multiple assignments with attention to details and deadlines in a high volume environment.
- Excellent organization skills and attention to detail
- Familiar with Word, Excel, Microsoft Office
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- Job Family Claims/Operations
- Pay Type Salary
- Headquarters Office, 625 State Street, Schenectady, New York, United States of America