POSITION SUMMARY/RESPONSIBILITIES
Manages and directs the activities of analysts, auditors, claims processors and other claims support staff as assigned. Researches and resolves escalated provider issues initiated by claim processors. Provides written and telephonic resolutions to external customer issues (with both providers and members) in accordance with the health plan's policies and procedures. Develops claim procedure improvement methodology(s), directions and strategic plans for procedural improvement to support Community First Health Plans' (Community First) business plan.
EDUCATION/EXPERIENCE
Minimum of two years college level work in business, health care administration or a related area is required. College requirement may be substituted for five years claims experience, including two years at the management level. Medicaid, Medicare and/or Commercial claims experience is strongly required. QNXT experience highly desirable.
