Claims Manager, South San Francisco, CA
The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Manager. This role will manage the functional operation of assigned claims activities. This may include claims processing, claims adjudication, or/and quality assurance.
The essential duties and responsibilities will include the following:
- Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner.
- Develop strategies and schedules for meeting stated goals.
- Continuously monitor and evaluate unit performance and take steps to improve the efficiency and quality of unit operations.
- Create and update unit procedures, workflows, and resource material.
- Effectively implement and maintain processes and workflows to meet the needs of internal and external customers.
- Implement necessary policy and regulatory changes.
- As required, develop and manage auditing and quality control processes.
- Be available as a resource and functional area expert to other HPSM employees.
- Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows
- Maintain knowledge of industry trends, best practices, and regulatory requirements.
- Facilitate and document meetings.
- Perform other duties as assigned.
Education and Experience:
- Bachelor’s degree in business, finance or related field.
- Five (5) years of claims management experience with at least two (2) years in a supervisory role.
- Medi-Cal and Medicare programs.
- Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint.
- Supervisory principles and practices as well as techniques and methods to organize and manage direct reports
- Manage multiple priorities of a complex nature and meet deadlines.
- Motivate, guide and lead staff to excellence.
- Communicate effectively, verbally and in writing.
- Analyze and problem solve, making good decisions.
- Provide excellent customer service.
Starting Compensation Range: - Depends on Experience
Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.
Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: firstname.lastname@example.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE
Submissions without a Cover Letter and Salary Expectations may not be considered.