Claims Director
Location: Los Angeles, CA
Schedule: Full Time / Hours between 8am & 5pm.
Pay: $71.07- $81.73 - Depending on Experience
Job Type: Temporary Assignment
Job Summary:
The Director, Claims position has overall responsibility and accountability for all aspects of claims operations while effectively and efficiently delivering and enhancing the claims processing experience. This position is responsible for overseeing the daily claims, including timely and accurate processing of specialty claims for managed care members. The Director will leverage experience and integrate various components of cross-functional business decisions to continuously improve claims’ processes and procedures. This position oversees the claims inventory by setting, evaluating, and monitoring the claims inventory baseline and examiner productivity metrics to ensure the timely and accurate processing of claims in compliance with regulatory requirements and organizational expectations.
Key Responsibilities:
This position will participate in various forums, company initiatives, and other internal/external workgroups to support Claims integrity. Directs all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports. Additional responsibilities include supervision and training of department staff, compliance with health plan and governmental regulations and standards, coordinating and overseeing health plan audits, and generations of management reports for fiscal and productivity analysis
Work Environment:
Work is in an office environment, climate controlled through central air conditioning
Required Skills and Abilities:
- Through knowledge of Managed Care regulations and compliance guidelines.
- Ability to audit and conduct performance evaluations of department and staff
- Knowledge of healthcare reimbursement and billing procedures, CPT and ICD-9 coding, and medical terminology
- Strong computer skills, proficiency in Microsoft Office programs-MS Word, Excel, EZCAP experience preferred
- Preferred health plan or hospital experience
- Bachelor’s degree or equivalent required.
- Minimum of 8 years of experience in the areas of managed care Health Care Claims management required.
- Minimum of 2 years of prior supervisory experience also required.
- Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas.
- Must be able to present findings to various levels of management, across all organizations.
