Director of Claims

New Orleans, Full time

The Claims Director will be accountable for providing leadership for the Claims Team by organizing, managing and directing the personnel and workflow to achieve timely and accurate disposition of claims to maintain production standards and quality results.

Business Quality Management:
•              Planning, scheduling, and directing the activites of the department to achieve service performance and retention targets;
•              Position team for successful management of new and existing products;
•              Provide effective oversight of Third Party Administrators and other business partners;
•              Participate in due diligence process as needed.

   Team Management:
•              Effective supervision, including hiring, training, scheduling, work allocation and problem resolution;
•              Responsible for performance evaluation of team members and making recommendations for appropriate action, as well as motivating team members to achieve peak performance and productivity;
•              Continuing education and development of team members to adapt to sales deviations and business restructuring;
•              Maintain a reliable staffing model to ensure appropriate staffing levels.

Process Management:
•              Manage processes to achieve maximum efficiency while maintaining service standards;
•              Support business initiatives through resource sharing and collaboration.
•              Participate in IT prioritization process and provide oversight of IT projects and enhancements;
•              Provide input into strategic decisions that affect the functional area of responsibility;
•              Resolution of escalated issues arising from operations and requiring coordination with other teams;
•              Support Corporate strategic initiatives internally and externally;
•              Seek process improvement to increase automation and efficiency gains.

Knowledge, Skills and Abilities:

  • Working knowledge of CPT and ICD-10 codes, UB-04 claim forms, HCFA 1500, HIPAA, medical terminology, appeal process, billing and insurance regulations and insurance benefits;
  • Self-starter with strong analytical, organizational and time management skills;
  • Excellent written and oral communication skills;
  • Ability to work with matrix partners and manage competing deadlines;
  • Possess current knowledge of technologies in the health information sector and their applications.
  • Strong interpersonal skills.

 

 

 

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