Job Description

Job Title: Sr. Claims Manager
Job ID: 659267
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:

Are you a dynamic leader with strong health insurance experience?  If so, UPMC Health Plan's Sr. Claims Manager may be the perfect next step in your career.The senior claims manager reports to the Director of Operations and assumes responsibility for directing all activities related to claims administration. This position is responsible for providing leadership and direction to supervisory and manager level staff to meet or exceed UPMC Health Plan business objectives.

Responsibilities:
  • Analyze and trend claims related data to identify inefficiencies and implement process improvement;
  • Lead work groups that encompass system users, claims processors, and other to identify problems and propose systematic solutions, and develop/maintain necessary work plans.
  • Maintain a positive work environment for direct management reporting staff, ranging from 5-7, with line staff of up to 200.
  • Maintain designated standards established for handling incoming work.
  • Maintains compliance accountability specific to claims administrations in accordance with applicable state and federal laws (s);
  • Manage and direct all activities and special projects.
  • Manage claims operating budget in excess of ($5,000,000).
  • Manages and directs staff, supporting professional growth by providing education, training and appropriate resources.
  • Must have the ability to effectively interact with internal and external customers.
  • Provide central coordination and control for implementation of new/changed application and systems.
  • Provide leadership and direction through developing and updating procedures, programs, determining appropriate standards and procedures, determining staffing requirements, and training opportunities.
  • Recruit and discharge employees when necessary.
  • Serve as liaison to clients with participation in demonstration of operations activities to prospective clients as well as maintenance of communication with established clients.

Qualifications

  • Bachelors Degree preferred or equivalent business experience of five (5) years.
  • Five years minimum management experience required. 
  • Experience in multi-million dollar budget preparation preferred; Expert knowledge of medical terminology, ICD-9, and CPT coding required; Incumbent must have strengths in methods and techniques of business process automation.  
  • Proficient knowledge in MS Office and PC skills preferred. 
  • Able to demonstrate excellent organizational, interpersonal, and communication skills. 
  • Maintain designated production and quality standards required. 
  • Ability to react to users needs in a timely and efficient manner and direct staff with minimal amount of supervision.
  • Previous experience with compliance preferred.
  • Previous experience with government products preferred.
  • Analytical skills preferred. 
  • Five years of health insurance experience preferred. 
  • Medical Claims experience preferred. 

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $32.95 to $55.80

Union Position: No

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