Professional Claims Leader

Professional Claims Leader for a large managed care organization in White Plains, NY


We are seeking a seasoned professional who can handle the several important elements of this important Claims program.

These include: Client relationship management Participation in the sales cycle for new business Oversight of the day-to-day operations of this new product Supervisory skills Excellent written and oral communications

Candidate will work with many key executives and will have to develop and maintain solid working relationships in a matrix-type environment. Candidate will be responsible for staffing and operational aspects of program performance. Candidate will assure the needed inter-relationships with Medical Directors, Medical lnformatics, Claims and Correspondence functions are maintained at a high level of effectiveness, Candidate will manage the day-to-day cost/ transaction nature of the product operations. A willingness to be open to process improvement and a strong commitment to CQI are essential.
Major elements of the product operations will include:

·  Hiring and staff supervision (includes line managers)

·  Establishing and monitoring performance metrics

·  Working to streamline and simplify the Medical Director review component of this product

·  Establishing (and improving) alt needed recordkeeping and information collection to support Medical Informatics functions

·  Focusing on the client and provider aspects of this product to improve its acceptance in the community and to enhance its value to the client and company.

Skills and experience that would be of great value: National account-type client relationship experience Line management of a production environment and large managed care company experience Familiarity with medical claim payment processes and terminology Excellent interpersonal skills
 

Salary up to $125,000 with comprehensive benefits