Claims Systems Manager
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Job Description
Claims Systems Manager leading claims software, vendors, and analysts for Vaya Partners’ health systems. Driving strategic roadmaps, projects, and North Carolina Medicaid compliance.
Responsibilities:
- Provide strategic leadership and oversight to the Claims Systems Analyst Supervisor(s) team
- Hire, supervise, evaluate, and mentor the Claims System Analyst team
- Monitor workload and business requirements to maintain adequate staffing and productivity
- Facilitate the design, development, implementation, and operation of claims management and associated software systems
- Provide daily status updates to upper management as directed by the VP of Business Services
- Monitor, track, and escalate Business Requirements Documents, vendor contracts, and service desk ticket resolution
- Oversee and participate in software application selection, implementation, and maintenance
- Allocate project and support resources in alignment with divisional and organizational priorities
- Complete project reports and documentation on project health and status
- Develop and communicate organizational vision and direction to the Claims System team and stakeholders
- Ensure complex projects align with ISD architecture, infrastructure, and business goals
- Identify and define the claims management system vision, roadmap, and growth opportunities
- Evaluate and prioritize feature backlogs and development requests
- Manage vendor relationships and act as an escalation point for staff and stakeholders
- Coordinate across ISD teams to prioritize and deliver projects, reports, and enhancements within stated timeframes
- Ensure claims management technologies are used according to policies and procedures
- Apply knowledge of North Carolina Medicaid rules and regulations
- Perform other duties as assigned
Requirements:
- Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or closely related field
- Seven (7) years of experience in management of data systems, with focus on claims or health insurance systems a plus
- Minimum of five (5) years of experience in a management/supervisory role
- In-depth understanding of physical and behavioral health claims processing software systems
- Knowledge of insurance principles, practices, federal and state regulations, and North Carolina Medicaid rules and laws
- Understanding of project management methodologies and tools
- Knowledge of business analysis techniques and tools, including creation and management of Business Requirement Documents
- Proven ability to lead and manage medium to large teams effectively
- Exceptional written and verbal communication skills
- Excellent analytical and problem-solving skills
- Proficiency with claims management software, data analysis tools, project management software, Microsoft O365 suite, and service desk ticketing software
- Ability to create reports, pivot tables, and presentations
- Ability to manage vendor relationships and use conflict resolution methods
- Ability to define and implement strategic roadmaps aligned with organizational goals
- Keen attention to detail and ability to ensure accuracy and compliance
- Ability to make informed decisions quickly and effectively
- Ability to cultivate working relationships with internal and external stakeholders
- Must live in Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia
Benefits:
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 13 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
- Public Service Loan Forgiveness Qualifying Employer
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