Claims Director at Kforce Inc in Montebello, California

Job Description:

RESPONSIBILITIES:

Kforce has a healthcare client in LA in need of Claims Director.

Summary:
The Claims Director has overall responsibility and accountability for all aspects of claims operations while effectively and efficiently delivering and enhancingthe claims processing experience. This position is responsible for overseeing the daily claims, including timely and accurate processing of specialty claims for managed care members. The Director will leverage experience and integrate various components of cross-functional business decisions to continuously improve claims' processes and procedures. Additional responsibilities include supervision and training of department staff, compliance with health plan and governmental regulations and standards, coordinating and overseeing health plan audits, and generations of management reports for fiscal and productivity analysis.

Responsibilities:

• Oversees the claims inventory by setting, evaluating, and monitoring the claims inventory baseline and examiner productivity metrics to ensure the timely and accurate processing of claims in compliance with regulatory requirements and organizational expectations


• Participate in various forums, company initiatives, and other internal/external workgroups to support Claims integrity


• Directs all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports

REQUIREMENTS:

• Bachelor's degree or equivalent required


• 8+ years of experience in the areas of managed care Health Care Claims management required


• 2+ years of prior supervisory experience also required


• Must be highly collaborative and maintain a consultative style with ability to establish credibility quickly with all levels of management across multiple functional areas


• Must be able to present findings to various levels of management, across all organizations.


• Strong verbal and written communication skills


• Strong leadership skills, emphasizing interpersonal and functional abilities


• Through knowledge of Managed Care regulations and compliance guidelines


• Ability to audit and conduct performance evaluations of department and staff


• Ability to follow and communicate complex instructions and directions


• Strong computer skills, proficiency in Microsoft Office programs-MS Word, Excel, EZCAP experience preferred


• Knowledge of healthcare reimbursement and billing procedures, CPT and ICD-9 coding, and medical terminology


• Ability to plan prioritize and schedule multiple work assignments; high degree of organization and time management skills

Physical Requirements:

• Work is sedentary, involving sitting at a PC and typing, with some occasional lifting, carrying, bending


• Reaching for and handling records, files, reports


• Frequent talking and hearing one-one-one, via phone and in groups


• Work is in an office environment, climate controlled through central air conditioning

The pay range is the lowest to highest compensation we reasonably in good faith believe we would pay at posting for this role. We may ultimately pay more or less than this range. Employee pay is based on factors like relevant education, qualifications, certifications, experience, skills, seniority, location, performance, union contract and business needs. This range may be modified in the future.

We offer comprehensive benefits including medical/dental/vision insurance, HSA, FSA, 401(k), and life, disability & ADD insurance to eligible employees. Salaried personnel receive paid time off. Hourly employees are not eligible for paid time off unless required by law. Hourly employees on a Service Contract Act project are eligible for paid sick leave.

Note: Pay is not considered compensation until it is earned, vested and determinable. The amount and availability of any compensation remains in Kforce's sole discretion unless
and until paid and may be modified in its discretion consistent with the law.

This job is not eligible for bonuses, incentives or commissions.

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.

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