Senior Claims Manager

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
A minimum of two (2) years' college-level work in business, healthcare administration or a related area is required. College requirements may be substituted for five (5) years' claims experience, including two years at the management level. Medicaid, Medicare and/or Commercial claims experience is strongly required. QNXT experience is highly desirable.