Claims Manager
UHS
Summary
This position reports to the Director of Operations and is responsible for managing claims for Commercial, ASO and Medicare products. Provide training to staff in accordance with contracts, rules, regulations, company policies and procedures. Oversees and coordinates interaction with various health plan departments. Coordinates production of all health plan products ensuring that all claims are paid in a timely manner. Responsible for resolving questions regarding claim payments and benefits.
Job description
Job Summary
This position reports to the Director of Operations and is responsible for managing claims for Commercial, ASO and Medicare products. Provide training to staff in accordance with contracts, rules, regulations, company policies and procedures. Oversees and coordinates interaction with various health plan departments. Coordinates production of all health plan products ensuring that all claims are paid in a timely manner. Responsible for resolving questions regarding claim payments and benefits.
Qualifications and Requirements
- Bachelor's Degree or equivalent experience
- Five (5) years minimum experience in a health plan environment
- Five (5) years minimum experience in Medicare/Medicaid claims processing
- At least two (2) years previous supervisory experience
- Minimum two (2) years' experience in advanced computer systems
- Ability to effectively communicate in English, both verbally and in writing
- Excellent skills in Microsoft Excel, Word and Access
- Ability to plan, organize, and maintain priorities and schedules, ensuring deadlines are met
- Excellent verbal and written communication skills, organizational skills, ability to interpret and apply established policy and procedure for all Health Plans products
- Excellent human relation skills in interpersonal contacts, high personal motivation and ability to work independently, high professional judgment and behavior
- Evidence of team collaboration, creativity, integrity, self-confidence and commitment to quality service
- Ability to maintain confidentiality
- Interpersonal skills necessary to deal with a diverse group of individuals as well as establish strong cooperative working relationships
- Ability to identify trends, potential problems and recommend corrective action and/or program/procedural development
Requirements
- Bachelor's Degree or equivalent experience
- Five (5) years minimum experience in a health plan environment
- Five (5) years minimum experience in Medicare/Medicaid claims processing
- At least two (2) years previous supervisory experience
- Minimum two (2) years' experience in advanced computer systems
- Ability to effectively communicate in English, both verbally and in writing
- Excellent skills in Microsoft Excel, Word and Access
- Ability to plan, organize, and maintain priorities and schedules
- Excellent verbal and written communication skills
- Excellent organizational skills
- Ability to interpret and apply established policy and procedure
- Excellent human relation skills
- High personal motivation and ability to work independently
- High professional judgment and behavior
- Evidence of team collaboration, creativity, integrity, self-confidence
- Commitment to quality service
- Ability to maintain confidentiality
- Interpersonal skills to deal with a diverse group of individuals
- Ability to establish strong cooperative working relationships
- Ability to identify trends, potential problems and recommend corrective action
Benefits
- Loan Forgiveness Program
- Paid Time Off
- Medical, Dental & Vision
- Prescription Drug Plan
- 401(k) Matching
- Discounted Stock Plan
- Student Loan Refinancing
- Career Development
Company overview
Universal Health Services, Inc. (UHS) is one of the nation's largest and most respected providers of hospital and healthcare services, operating as a Fortune 300 corporation headquartered in King of Prussia, Pennsylvania. Founded in 1979, UHS has grown into a major healthcare enterprise with approximately 99,000 employees and annual revenues exceeding $14 billion. The company operates through its subsidiaries, managing 29 acute care hospitals, 331 behavioral health facilities, and 60 outpatient and other facilities across 39 U.S. states, Washington D.C., Puerto Rico, and the United Kingdom. UHS provides comprehensive healthcare services including acute care, behavioral health treatment, cancer centers, and ambulatory surgical centers. The company's strategy focuses on building or acquiring high-quality hospitals in rapidly growing markets and investing in advanced medical equipment and skilled personnel to become the leading healthcare provider in each community it serves. UHS is publicly traded on the New York Stock Exchange (NYSE: UHS) and has established a strong reputation for delivering compassionate, high-quality care while maintaining financial stability and operational excellence.