Lead Claims Examiner

Description

Arizona Claims Unit

Purpose: The Claims Team Leaders are instrumental in the development, implementation and documentation of processes, policies and procedures required to meet federal and state regulatory guidelines with the department.

Responsibilities:
Responsible for developing, implementing and documenting workflow processes within an automated claims adjudication unit. Monitors unit activities and work processes as necessary to meet dept goals.
Facilitates teamwork processes within unit and within cross-departmental teams as requested. Serves as the project lead for assigned team projects as requested.
Recruits, orients, trains, evaluates, and monitors on-the-job performance of unit personnel.
Supports the goals and objectives of all claims operations with logistics, communications and other duties as assigned.

Requirements

Demonstrated understanding of workflow processes between key functions in claims, contracting and authorizations as requirement for success in this position.
Prior direct workflow supervision of a significant staffing number (may vary depending on Claims Team Leader specific position).
Bachelor's degree preferred in healthcare or business related field, with extensive experience in healthcare and claims/audit.
Ability to resolve conflicts, which may involve constructive assertiveness and/or confrontation.
Working knowledge of IPA/Medical Group operational workflow in relation to health plan operations (will vary depending on Claims Team Leader specific position).

Education:
High school graduate; 2 years college preferred.

SCAN is an Equal Opportunity Employer