1+ months

Manager, Claims Research and Resolution

Humana
Louisville, KY 40290
Description The Manager, Claims Research & Resolution manages claims operations that involve customer contact, investigation, and settlement of claims for and against the organization. Approves all claim settlements both for and against the organization. The Manager, Claims Research & Resolution works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules and goals. Responsibilities The Manager, Claims Research & Resolution will oversee the daily operations of the claims research and resolution team that is comprised of a group of claims specialists researching the resolution to pending claims. Decisions by the Manager are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. This role will require cross departmental collaboration, and conducts briefings and area meetings; maintains frequent contact with other managers across the department. **This position may require up to 25% overnight travel depending on business needs. Primary Responsibilities + Oversee and successfully manage the daily operations of the claims research and resolution team + Lead the development, training, evaluation, and coaching of qualified claims specialists staff + Manage supervisors, who are responsible for claims specialists + Ensure sufficient staffing to guarantee prompt resolution of claims + Monitor claims operations performance reports to ensure compliance with CMS and multi-state Medicaid standards + Manage quality metrics for claims research and resolution team to ensure performance standards are met + Oversee department budget Required Qualifications + Bachelor's Degree and equivalent work experience + 3+ years of healthcare claims payment experience + Minimum 2 years of leadership experience over a large metric-intensive operational unit with a span of control between 25-100 associates + Demonstrated capability with coaching and developing associates formally and informally + Ability to communicate and collaborate across multi-business units within Humana + Must be passionate about contributing to an organization focused on continuously improving consumer experiences + Demonstrated problem solving skills; ability to give direction and make sound business decisions + Experience with department budget oversight + Must be able to travel up to 25% overnight depending on business needs Preferred Qualifications + Prior experience in Medicare and Medicaid + Previous management experience in healthcare industry Scheduled Weekly Hours 40 About Us Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms when and where they need it. Our employees are at the heart of making this happen and thats why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first. Equal Opportunity Employer It is our policy to recruit, hire, train, and promote people without regard to race, color, religion, sex, national origin, age, sexual orientation, gender identity or expression, disability, or veteran status, except where age, sex, or physical status is a bona fide occupational qualification. View the EEO is the Law poster. If you are an individual with a disability and require a reasonable accommodation to complete any part of the application process, or are limited in the ability or unable to access or use this online application process and need an alternative method for applying, you may contact mailbox_tas_recruit@humana.com for assistance. Humana Safety and Security Humana will never ask, nor require a candidate provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact mailbox_tas_recruit@humana.com to validate the request. <>

Categories

Posted: 2019-10-23 Expires: 2020-01-10

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Manager, Claims Research and Resolution

Humana
Louisville, KY 40290

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast