Manager Business Procedures - Claims

Now hiring a Manager Business Procedures.

As a Manager Business Procedures, you will be accountable and responsible for oversight of the day to day operations of the Claims department specialty teams: Claims Resource and Support Team (CRST), Claims CARE Unit, Financial Recovery and Subrogation team and the Coordination of Benefits (COB) team. CRST acts as a resource to claims staff, providing process documentation and guidance for system issues, training of policies, procedures and processes, program operations and regulatory compliance requirements. Integrates quality and process initiatives into desktop policies and procedures. Works closely with staff to ensure policies and procedures comply with regulatory compliance requirements.  The Financial Recovery team ensures all receivables are logged, researched, claims are adjusted/posted. The Subrogation team is responsible for initiation and maintenance of all subrogation claims from investigation through collection on cases involving all applicable product types. The Coordination of Benefits (COB) team is responsible for performing complex research within the Claims Department for multiple lines of business for claims that could involve other insurance, including but not limited to auto insurance, workers compensation and other health insurance. Collaborate with multiple internal departments, vendors, providers and customers.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

 

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, and Ohio

Ideal Candidate: Bachelor's degree is required.  Six years of additional experience can be substituted in lieu of degree.
Must have three years experience in the medical or health insurance field at a supervisory level.

• Bachelors Degree in business administration or related field required. Six years of additional experience can be substituted in lieu of degree.
• Three years experience in the medical or health insurance field at a supervisory level.
• Strong working knowledge of provider and benefit contract interpretation with high-level knowledge and expertise in all business segments in the health insurance field.
• Intermediate level proficiency with Windows based software such as Word and Excel.
• Good organizational skills and ability to function effectively under stress
  
  

• Provides direct supervision to the Supervisors. Proactively assists the Supervisors in development of leadership skills. Assures the efficiency and effectiveness of all departmental policies and procedures.
• Ensures that the employment practices of the Claims Department are consistent with the corporation's equal employment opportunity objectives. Works with staff and other departmental personnel to coordinate and develop corrective action plans in order to address substandard performance.
• Provides written evaluations to every directly supervised employee annually.
• Responsible for evaluation of appropriate staffing levels to ensure the department can successfully meet contractual performance requirements.
• Administers performance management for the work units to achieve positive department and organizational performance results with a focus on creating an exceptional patient member experience.
• Consistently sets a positive example as a leader including, but not limited to, attendance, code of conduct and work ethic. Provides direct supervision to supervisors with a wide range of job functions, all of whom support the Claims organization as a whole.
• Meets all regulatory, contractual, operational standards, and goals related to the performance and services of the claims function, including achievement of time to pay requirements and all internal and external quality levels.
•  Serves as an integrator and business partner with the appropriate internal and client stakeholders to identify barriers impacting the customer experience and develop solutions with One Presbyterian as the focus. Ensures continual calibration with peers, external clients and vendors.
• Performs other functions as required.

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

#PHP123

USD $47.83/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.