Manager of Claims - Health Plans
3.
3 Corvallis, OR Corvallis, OR Estimated:
$75.
4K - $95.
4K a year Estimated:
$75.
4K - $95.
4K a year Relocation Allowance (up to):
$10,000 Samaritan Health Services Req #:
67849 Corvallis, OR 1.
0 (80 hrs/pp) - Day SHS Health Plan Ops - Claims Remote Status:
Hybrid Bonus available to new employees and may require previous work experience.
Employment commitment to Samaritan is required.
Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members.
SHP operates a portfolio of health plan products under several different legal structures:
InterCommunityHealth Plans, Inc.
(IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.
offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
This is a hybrid position in which the Manger of Claims will be expected to be onsite in Corvallis, OR at least 2-3 times a week or more based on team and business need.
JOB SUMMARY/PURPOSE Oversees and manages the Samaritan Health Plans Claims Department.
Is responsible for accurate and timely claims processing for all programs administered by Samaritan Health Plans.
Provides oversight to staff and ensures that the organization's performance expectations, financial standards, and goals are achieved.
Enhances department bench strength by hiring, coaching and mentoring direct reports.
Responsible for the completion and success of all internal and external claims audits.
Analyzes claims data and ensures compliance requirements are met.
EXPERIENCE/EDUCATION/QUALIFICATIONS Bachelor's degree in healthcare or a related field, or equivalent direct claims experience required.
Three (3) years management experience in a health plan claims department required.
Experience or training in the following required:
Collecting, analyzing and displaying statistical reports by computerized technology.
Basic medical terminology.
Medicare and/or Medicaid experience preferred.
KNOWLEDGE/SKILLS/ABILITIES Leadership - Inspires, motivates, and guides others toward accomplishing goals.
Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation.
Proactively resolves conflicts in a positive and constructive manner.
Critical thinking - Identifies complex problems.
Involves key parties, gathers pertinent data and considers various options in decision making process.
Develops, evaluates and implements effective solutions.
Communication and team building - Leads effectively with excellent verbal and written communication.
Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
PHYSICAL DEMANDS Rarely (1 - 10% of the time) Occasionally (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 - 100% of the time) LIFT (Floor to Waist:
0-36) 0-20 Lbs LIFT (Knee to chest:
24-54) 0 - 20 Lbs LIFT (Waist to Eye:
up to 54) 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds CARRY 2-handed, 0 - 20 pounds KNEEL (on knees) BEND FORWARD at waist CLIMB - STAIRS STAND WALK - LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0-20 pounds force) PULL (0-20 pounds force) SIT ROTATE TRUNK Sitting REACH - Forward MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist None specified Bachelor's degree in healthcare or a related field, or equivalent direct claims experience required.
Three (3) years management experience in a health plan claims department required.
Experience or training in the following required:
Collecting, analyzing and displaying statistical reports by computerized technology.
Basic medical terminology.
Medicare and/or Medicaid experience preferred.
Leadership - Inspires, motivates, and guides others toward accomplishing goals.
Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation.
Proactively resolves conflicts in a positive and constructive manner.
Critical thinking - Identifies complex problems.
Involves key parties, gathers pertinent data and considers various options in decision making process.
Develops, evaluates and implements effective solutions.
Communication and team building - Leads effectively with excellent verbal and written communication.
Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
3 Corvallis, OR Corvallis, OR Estimated:
$75.
4K - $95.
4K a year Estimated:
$75.
4K - $95.
4K a year Relocation Allowance (up to):
$10,000 Samaritan Health Services Req #:
67849 Corvallis, OR 1.
0 (80 hrs/pp) - Day SHS Health Plan Ops - Claims Remote Status:
Hybrid Bonus available to new employees and may require previous work experience.
Employment commitment to Samaritan is required.
Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members.
SHP operates a portfolio of health plan products under several different legal structures:
InterCommunityHealth Plans, Inc.
(IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc.
offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services' self-funded employee health benefit plan.
As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.
This is a hybrid position in which the Manger of Claims will be expected to be onsite in Corvallis, OR at least 2-3 times a week or more based on team and business need.
JOB SUMMARY/PURPOSE Oversees and manages the Samaritan Health Plans Claims Department.
Is responsible for accurate and timely claims processing for all programs administered by Samaritan Health Plans.
Provides oversight to staff and ensures that the organization's performance expectations, financial standards, and goals are achieved.
Enhances department bench strength by hiring, coaching and mentoring direct reports.
Responsible for the completion and success of all internal and external claims audits.
Analyzes claims data and ensures compliance requirements are met.
EXPERIENCE/EDUCATION/QUALIFICATIONS Bachelor's degree in healthcare or a related field, or equivalent direct claims experience required.
Three (3) years management experience in a health plan claims department required.
Experience or training in the following required:
Collecting, analyzing and displaying statistical reports by computerized technology.
Basic medical terminology.
Medicare and/or Medicaid experience preferred.
KNOWLEDGE/SKILLS/ABILITIES Leadership - Inspires, motivates, and guides others toward accomplishing goals.
Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation.
Proactively resolves conflicts in a positive and constructive manner.
Critical thinking - Identifies complex problems.
Involves key parties, gathers pertinent data and considers various options in decision making process.
Develops, evaluates and implements effective solutions.
Communication and team building - Leads effectively with excellent verbal and written communication.
Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
PHYSICAL DEMANDS Rarely (1 - 10% of the time) Occasionally (11 - 33% of the time) Frequently (34 - 66% of the time) Continually (67 - 100% of the time) LIFT (Floor to Waist:
0-36) 0-20 Lbs LIFT (Knee to chest:
24-54) 0 - 20 Lbs LIFT (Waist to Eye:
up to 54) 0 - 20 Lbs CARRY 1-handed, 0 - 20 pounds CARRY 2-handed, 0 - 20 pounds KNEEL (on knees) BEND FORWARD at waist CLIMB - STAIRS STAND WALK - LEVEL SURFACE ROTATE TRUNK Standing REACH - Upward PUSH (0-20 pounds force) PULL (0-20 pounds force) SIT ROTATE TRUNK Sitting REACH - Forward MANUAL DEXTERITY Hands/wrists FINGER DEXTERITY PINCH Fingers GRASP Hand/Fist None specified Bachelor's degree in healthcare or a related field, or equivalent direct claims experience required.
Three (3) years management experience in a health plan claims department required.
Experience or training in the following required:
Collecting, analyzing and displaying statistical reports by computerized technology.
Basic medical terminology.
Medicare and/or Medicaid experience preferred.
Leadership - Inspires, motivates, and guides others toward accomplishing goals.
Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation.
Proactively resolves conflicts in a positive and constructive manner.
Critical thinking - Identifies complex problems.
Involves key parties, gathers pertinent data and considers various options in decision making process.
Develops, evaluates and implements effective solutions.
Communication and team building - Leads effectively with excellent verbal and written communication.
Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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