Description: Under management direction, responsible for supervising the functions and activities in the Claims Department to ensure timeliness and propriety of claims payments. This position is responsible for supervising the claims processing function for Knox-Keene licensed health maintenance organization (HMO).
Requirements: High School diploma from an accredited school or equivalent. Four (4) years of supervisory level medical claims payment processing experience OR Bachelor's degree in business administration or related field AND two (2) years of administrative or supervisory experience in a medical claims payment processing operation OR any equivalent combination of training and experience. Health maintenance organization (HMO) claims payment-processing experience is highly desirable. Knowledge of computerized on-line data entry systems; organizational structure of medical claims processing; methods and procedures utilized in medical claims processing; supervisory and training techniques; medical terminology; medical reimbursement methodologies; ICD-9 & CPT coding. Ability to adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities; communicate with a variety of personnel and providers; prepare management reports; effectively supervise and train staff. Possession of valid driver’s license and proof of State required auto liability insurance. Required Travel Up to 10%
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.