Director of Claims

US-AZ-Phoenix
Job ID
2017-2600
# Positions
1
Category
Management

Overview

Leads and directs claims functions of JFCS and is accountable for business results through cost-effective and timely resolution of claims. In conjunction with Senior Management, works within assigned limits of the highest authority on assignments requiring the highest degree of technical complexity and coordination.

Responsibilities

  •  Contributes to profitability by effective implementation of claims handling using best practices to manage loss cost and claims expenses.
  • Directs the work activities of subordinate staff and manages insurance-related client issues. Ensures annual productivity and profitability goals are met.
  • Develops and manages staff training programs, i.e., review of damages, documentation, coverage, overturning denials, effective processing.
  • Reviews and directs the application of claims policies, guidelines, insurance laws and regulations by subordinate staff. Manages file reviews to ensure company compliance guidelines are followed.
  • Develops and implements operating plans for enhancing the business and meeting strategic objectives.
  • Participates with Senior Management in the development and implementation of claims policies and business strategy.
  • Reports business progress to Senior Management.
  • Keeps current on state/contractual regulations and issues, industry activities and trends. Ensures billing ethics and reviews for fraud.
  • Ensures all Claims Department timelines and deadlines are met within required parameters.
  • Maintains full knowledge of billing requirements for all payers, keeping CFO/COO and Claims staff updated with any billing/payment changes to current practice.
  • Ensures reconciliation of cash received to cash posted is done on a monthly basis.
  • Manages Third Party claims.

Qualifications

Bachelor’s Degree preferred.

 

  • Minimum of 10 years’ claims experience in a healthcare or managed care environment including supervisory/management experience with a proven track record of results.
  • Working knowledge of Medicare and State AHCCCS.
  • Ability to interact effectively with all levels of JFCS internal and external business partners.
  • Technical and business management acumen, claims resolution skills and knowledge of third party liability insurance and claims principles, practices and procedures.
  • Excellent analytical and problem solving skills with the creativity in resolving unique and challenging business problems.
  • Highly organized.
  • Ability to manage multiple projects and teams.
  • Ability to achieve results by taking a proactive long-term view of business goals and objectives.

  • Knowledge of Microsoft Office Suite with emphasis using MS Excel to manipulate and communicate data.

  • Knowledge of NextGen EHR and EPM Software preferred.

  • Ability to exercise discretion and independent judgment with respect to matters of significance.

*CB

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