Job Description

Job Title: Senior Claims Manager - Operations Excellence
Job ID: 675877
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations Support
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

Purpose:
The Senior Manager, Operational Excellence assumes responsibility for directing all activities related to claims adjudication, operations and administration. The incumbent is responsible for the delivery of operational excellence services to the broader claims, provider services and inbound document processing operations group. To include such functions as business process analysis, improvement and optimization, functional analytics and reporting, workload forecasting, resource planning and scheduling, development and administration of performance standards, This position is responsible for providing leadership and direction to supervisory and manager level staff supporting a shared services approach and to meet or exceed UPMC Health Plan business objectives

Responsibilities:
  • Analyze and trend claims related data to identify inefficiencies and implement process improvements.
  • Design, develop, implement and support solutions to meet the medical and financial requirements of the Health Plan.
  • Develop and implement clear strategies and tactics to effectively support the needs the operational excellence department.
  • Interact and collaborate extensively with internal stakeholders and external customers to drive operational excellence and maintain positive relationships supporting business goals and objectives.
  • Lead work groups that encompass system users and developers to identify problems and propose solutions.
  • 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 operating budget in excess of ($5,000,000)
  • Protect the integrity and confidentiality of all data and patient information through physical and/or electronic means.
  • Provide direct leadership to a large staff of both exempt and nonexempt employees to maximize claims operations and operational optimization including coaching, developing, and administration of performance appraisals.
  • Provide direction to system support teams to analyze and evaluate customer business environments and works in conjunction with IT to develop requirements for system configuration solutions.
  • Provide leadership and direction through developing and updating procedures, programs, determining appropriate standards and procedures, determining staffing requirements, and training opportunities.
  • Recruit, develop, manage, and motivate high caliber management staff.
  • Responsible for identifying causes for variances and recommending corrective action interventions, systemic solutions or necessary short term actions.
  • Responsible for leveraging cross-functional resources to expand visibility and enhance predictability of expected results.
  • 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

  • Bachelor's Degree preferred with analytical or healthcare focus or equivalent business experience of eight years. 
  • Eight years minimum management experience required. 
  • Eight years experience in healthcare and/or operational analysis including the business process improvement discipline. 
  • Experience in multi-million dollar budget preparation preferred. 
  • High degree of professionalism, enthusiasm and initiative on a daily basis. 
  • Ability to work in a fast-paced environment required. 
  • Manage multiple tasks and projects, and forge strong interpersonal relationships within the department, with other departments, and with external audiences.  
  • Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity.  
  • Excellent planning, communication, documentation, organizational, analytical, and problem solving abilities. 
  • Advanced mathematical skills. Statistical background preferred. 
  • Ability to interpret and summarize results of various analyses in a timely and meaningful way. 
  • Ability to effectively approach problem solving. 
  • Ability to re-engineer processes to positively impact productivity in terms of timeliness and accuracy. 
  • Ability to analyze financial & operational results and to comprehend forecasting models. 
  • Well-informed and conversant with general business and operational matters.
  • Previous health insurance claims experience is preferred.

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

Salary Range: $36.31 to $61.51

Union Position: No

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