Director of Claims Processing

Company: Express Employment
Location: Irvine
Posted on: November 15, 2024

Job Description:

Top Job

Located in Irvine, CA

Salary: Competitive comp & benefits!

This is an outstanding opportunity to be a part of a rapidly growing organization with a fantastic culture and passion for their mission.

What You Get to Do!
The Director of Claims Processing is responsible for leading the operational team within the claims processing department, which provides operational support to the company's internal and external customers. This role involves developing and implementing system enhancements to streamline the claims handling process. It also entails creating and refining processes for collecting and maintaining claims data, conducting coverage reviews and evaluations, and providing educational and functional support for our claims and invoicing systems.
- Lead and manage a team to achieve high-level claims operations.
- Manage, develop, improve and implement processes to increase the efficiency and effectiveness of the claims department.
- Responsible for regulatory reporting initiatives.
- Respond to and resolve any potential issues highlighted during internal or external audits related to claims operations.
- Act as a liaison for the data governance council on the claims and litigation data dictionary.
- Oversee the quality and integrity of claims data.
- Manage the coverage review process to ensure timely reviews and responses.
- Collaborate with claims leadership to create and maintain a positive and integrated customer experience from initial claims intake through ongoing adjudication and resolution.
- Provide leadership and direction on new projects and initiatives.
- In conjunction with the data analytics team, perform data and claims analysis to support company and institutional goals.

What You Will Bring
- Bachelor's degree in Health Administration, Business Administration, or a related field. Master's preferred.
- Professional certifications such as Certified Professional Coder (CPC), Certified Medical Reimbursement Specialist (CMRS), or Certified Claims Professional (CCP).
- Experience with major healthcare claims processing systems and software.
- 8+ years of insurance operations experience (preferred)
- Knowledgeable of medical professional liability claims operations or other complex claims
- Demonstrated proficiency in management of staff and processes

To Apply: For confidential consideration, please submit resume to karen.turner@expresspros.com

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Express Office: Bend

296 Southwest Columbia Street

Suite B

Bend, OR 97702

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