Claims Manager

Summary/Position Objectives:
Reporting to the AVP of Claims Operations, this position manages the Claims Department personnel to ensure performance and compliance for the Customer Service Center of Schaller Anderson of Arizona LLC. Incumbent manages a personnel base of up to 100 employees. Incumbent is responsible of ensuring the Claims Department achieves optimum accuracy, efficiency, and productivity targets in claims administration and adjudication. Incumbent manages and monitors the performance of Claims Analysts, Coordination of Benefits, Data Entry, Claims Inquiry and Research, and Claims Quality Review and Training. Incumbent ensures compliance with Schaller Anderson policies, procedures, and standards.

Responsibilities:
Essential Functions:
Support the AVP of Claims Operations in development, coordination, and implementation of SAI and SAA strategic initiatives
Implement and enforce department operational standards, procedures, and policies to achieve and increase target production goals; recommend initiatives and programs to optimize and improve the department’s competitive position and profitability; advise supervisor regarding possible performance-enhancing technology and procedures
Monitor department performance, productivity, and accuracy by measurement systems and benchmarking; reward and reprimand as necessary
Assist with the preparation and dissemination of management reports and statements, detailing performance, production, quality, etc.
Assist with the implementation of new business lines and technological configuration and software conversions; supervise project plans; liaison with other personnel to effectuate smooth transition and growth
Identify, document, and report potential fraud, abuse, and misuse of medical resources
Manage department personnel, administrative, and training functions to ensure adequate staffing infrastructure and support; ensure personnel have current training

ABOUT SCHALLER ANDERSON:

Schaller Anderson administers Medicaid and employer self-funded health plans, and manages behavioral health plans. The company’s suite of services includes member services; provider services; claims processing; information services; financial reporting and analysis; medical management; and grievances and appeals services. Schaller Anderson has also been engaged in several consulting projects for states, health plans and providers. Schaller Anderson and its affiliates have 1,400+ employees nationwide and administer health plans with over 1.6 million members. Recently, the Initiative for a Competitive Inner City and Inc. magazine named Schaller Anderson to the Inner City 100, a list that recognizes the fastest-growing companies in America’s core urban areas. Schaller Anderson placed eighth among 5,000 entries in the Inner City 100 competition and was the only health care management company in the top 10.

The VISION of Schaller Anderson, Inc. is to be recognized as the nation’s foremost managed care resource by providing the highest value management and consulting services throughout the health care continuum.


BENEFITS:

Schaller Anderson team members are provided with countless opportunities to make a real difference and the following compensation/benefits:

* Competitive compensation DOE
* Medical, Dental and Vision insurance
* Employee Assistance Program
* Flexible spending accounts
* On-site fitness center (Phoenix headquarters only)
* Life insurance and accidental death and dismemberment insurance
* Short-term and long-term disability
* Paid holidays, paid time off/paid time off reserve
* 401(k) and profit sharing
* Tuition reimbursement
REQUIREMENTS
Knowledge and Skills:
Incumbent must have skills in management and advanced problem solving. Ability to read, comprehend, and negotiate services at an advanced level, to write correspondence, procedures and policies, schedules, supporting documentation, and budgets, to present information effectively in one-on-one and small group settings to providers, health plans, vendors and employees. In addition, incumbent must have the ability to use advanced reason to define problems, collect data, establish fact, draw valid conclusions, and design, implement, and manage appropriate action plans, the ability to perform detailed and disciplined work using standard methodologies in the analysis, design, development, evaluation, testing, documentation, and implementation in support of corporate health care goals related to the claims department, and the ability to establish and maintain constructive relationships with diverse management, employees, state regulators and vendors. Incumbent must have advanced and meticulous organizational and coordination skills and be able to handle multiple priorities. Incumbent must be able to successfully utilize Microsoft Office suite, including Excel, and common computer and office hardware. This position needs demonstrated skills in counseling, planning, training, and managing various staffing patterns.

Education and Work Experience:
Bachelor’s degree required; advanced education preferred. Incumbent must have at least three (3) years work experience in claims management, with at least one (1) of those years in a supervisory role. Demonstrated experience in health plan operations, and call-center management required. Experience with Medicare, Medicaid, and commercial (including self-funded) managed care programs as relating to claims administration preferred. Advanced interpersonal skills, maturity, and good judgment are required. Working experience with QMACS managed health care software is required. This position requires work experience in a complex, competitive environment with diverse racial and socioeconomic factors.