Priority Health
Health Care
DirectorClaimsAdministration
“Director Claims Administration at Priority Health. Skills: Claims Administration, Team Leadership, Process Improvement. Lead and develop claims adjudication team. Assure proper staffing levels”
What You'll Achieve.
Accurate, timely and efficient adjudication and payment of claims; Claim inventory management; Claim speed to process; Claim auto adjudication rate; Claim examiner quality scores; Coordination of benefits savings; Third party liability savings; Service-levels achievement; Medical trend management savings; Unit costs management
Industry & Context.
Process improvement; Cost-saving measures
Pallet to Waist (6" from floor) > 5 lbs: Seldom up to 10 lbs, Waist to Waist > 5 lbs: Seldom up to 10 lbs, Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs, Waist to Overhead > 5 lbs: Seldom up to 10 lbs, Bilateral Carry > 5 lbs: Seldom up to 10 lbs, Unilateral Carry > 5 lbs: Seldom up to 10 lbs, Pushing Force > 5 lbs: Seldom up to 10 lbs, Pulling Force > 5 lbs: Seldom up to 10 lbs, Sitting: Frequently, Standing: Occasionally, Walking: Occasionally, Forward Bend - Standing: Seldom, Forward Bend - Sitting: Occasionally, Trunk Rotation - Standing: Seldom, Trunk Rotation - Sitting: Occasionally, Reach - Above Shoulder: Seldom, Reach - at Shoulder or Below: Seldom, Handling: Occasionally, Forceful Grip > 5 lbs: Seldom, Forceful Pinch > 2 lbs: Seldom, Finger/Hand Dexterity: Frequently
What They're Looking For.
Must Have
Bachelor's Degree or equivalent education and experience, 10 years of relevant experience, Prior management experience
Nice to Have
2 years of relevant experience Prior claims administration management experience, Health care plan claims experience
What You'll Do.
Lead and develop claims adjudication team
Assure proper staffing levels
Implement goals setting
Achieve service-levels
Manage medical trend management savings
Ensure accuracy and timeliness of claim payment
Foster relationships with other departments
Initiate process improvement
Initiate cost-saving measures
Develop multi-year roadmaps
Meet targets for unit costs
Meet targets for service levels
Meet targets for coaching and development
Communicate issues and concerns verbally
Communicate issues and concerns in writing
Communicate operational issues to leadership
Ensure compliance with state and federal rules
How You'll Work.
Team & Collaboration
Foster and maintain relationships with other departments; Service on corporate committees
Communication Scope
Effectively communicate issues and concerns through verbal and written communications; Effectively communicate operational issues and concerns to leadership
Process & Methodology
Develop multi-year roadmaps
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