• Director of Claims

    Location US-AZ-Phoenix
    Job ID
    # Positions
  • 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.


    •  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.


    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.



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