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**Urgent Remote Hire**

The Claims Analyst is responsible for end-to-end Claim process automation, optimization, identifying and leveraging technology and data to improve the quality and minimize process cost of Claims for the company?s Management Services Organization (MSO). Through in-depth audit and review of Claims data, the Director will identify financial savings across all aspects of the company?s claims processes.

The Claims Analyst will provide strategic mindset and development of the Claims Department and its employees, as well as collaborate with other internal departments and client company (Business Partner) departments, as required, to ensure data integrity and to drive financial and operational value across all company and business partner health plans to maximize benefit coverage while containing cost.

The Claims Analyst will partner the leadership team to execute goals and plans. Through inter-professional collaboration, The analyst will ensure that the MSO and leadership teams are notified in a timely fashion of any changes in process or procedures which would impact their functions.

Direct the day-to-day operations of the claims department and ensure accurate and timely processing of members medical claims within established state, company, and business partner compliance guidelines.

• Develop and execute strategic initiatives and programs to enhance existing functions and develop new processes in support of corporate initiatives and requirements
• Health and or Self-Funded Benefits and Claims administration experience is a must.
• Health Benefits configuration experience preferred.
• Reinsurance Analyst experience beneficial.
• Plan Configuration in its entirety
• Claims Configuration setup
• Enrollment Configuration in its entirety
• Establish plans of action, allocation of resources, schedule overtime, etc., to ensure operational efficiency consistent with corporate and departmental goals
• Direct and oversee all Claims Department functions, including front end processing, adjustments, special pricing, recoupments, claims complaints, claims correspondence, benefit configuration, audit and testing
• Establish administrative priorities and accomplishments for each area; manage Area Directors and Managers
• Oversee and provide direction with the Director of Claims Manage the relationship with the TPA/BPO for claims processing
• Monitor claims inventory, cycle time processing and work quality to assure conformity with corporate objectives and goals
• Ensure adherence to all Legislative, Regulatory and Contractual requirements
• Conduct special projects including business analyses, strategic planning, and implementation efforts on new business acquisitions and changing corporate requirements
• Coordinate and supervise operational analyses and implementation support on major workflow and activity modifications
• Recommend changes for system design, methods, and workflows affecting the assigned departments
• Develop, implement, and maintain claims policies and procedures
• Manage the overall budget in support of the responsibilities of the areas and corporate initiatives and responsibilities
• Perform other duties, as needed
• Develop the vision and goals for the claims department in compliance with federal, state, Company, and Business Partner guidelines
• Act as Point with healthcare technology vendor to assure appropriate implementation, processes, interfaces, contracts, and training are fully executed and oversee full operational functions of the healthcare technology platform used for benefits and claims administration for the Company and its Business Partners.
• Oversee and ensure regulatory as well as organizational compliance of all claims processing guidelines.
• Direct the activities of assigned business units including strategic planning, problem-solving, staff development and communication.
• Develop goals and objectives for assigned business units that supports the organizations strategy, products and services.
• Collaborate across business units with key stakeholders to align business objectives.
• Oversee the development and implementation of business unit policies, systems and processes.
• Lead, direct, evaluate and develop business unit leadership and team members.
• Provide effective and efficient solutions to complex business problems.
• Prepare and present formal presentations, documents, updates, etc. to executive leadership.
• Partner with multiple business units, health plans and other stakeholders to establish operational objectives and procedures.
• Identify business needs and drive change initiatives to address these issues
• Ensure all issues are resolved accurately and timely and implement action plans to address any issues
• Identify and implement operational efficiencies and development of ?best practice? policies and procedures
• Analyze customer impact and respond to complex escalated customer service and claims processing issues to ensure that customer expectations are consistently met
• Exceptional Strategic Planning along with Program and Change Management skills preferred
• Ability to lead and drive multimillion dollar initiatives across organizational boundaries.
• Outstanding communication, leadership, and employee engagement skills.

Direct the day-to-day operations of the claims department and ensure accurate and timely processing of members medical claims within established state and company compliance guidelines.

Education/Experience:
Bachelor?s degree or equivalent experience. 7+ years of operations management, financial management or analysis, or claims operations experience, preferably in a managed care and/or Medicaid setting. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff.

Job Type: Full-time

Pay: $45,000.00 - $65,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Education:

• Bachelor's (Preferred)

Experience:

• Claims Configuration operation: 3 years (Preferred)
• Self-Funded Benefits and Claims administration: 3 years (Preferred)
• Plan Configuration: 3 years (Preferred)
• Enrollment Configuration: 3 years (Preferred)

Work Location: Remote