This position will provide leadership to the Claims Inventory, Claims Production, Provider Call Center and Claims Payment Integrity teams. He/she will be responsible for the tactical and strategic operations/direction of these teams. Being successful in this position includes exceeding provider expectations by ensuring world-class service and support to all of the company’s providers and members as well as providing claims processing services that surpass state/federal regulations and contractual obligations.
The Claims Inventory team handles all incoming claims and follows through until all claims are in the system. The Claims Product Team insures everything received is initially processed (onshore and offshore). The Claims Payment Integrity Team ensures all COB/TPL processes are followed. Creates all internal and external process documents as well as manages all claims recovery vendors. The Provider Call Center team handles all provider calls related to claims and ensures satisfactory closure of issues along with appropriate claims adjudication.
He/she will assess the impact of new business on the overall claims processes and implement initiatives in those areas that will provide the necessary operational support to contribute to successful expansion into new markets. He/she will identify dependencies on other areas and work with peers to ensure that operations are aligned with corporate goals.
Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.
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Neighborhood is an EOE M/F/D/V and an E-Verify Employer