Senior Manager Claims Resolution (Remote)

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make. Job Posting Title Senior Manager Claims Resolution (Remote) Job Description Summary The Sr. Manager of the Internal Resolution unit leads the internal resolution unit and assists the health plan in the resolution of complex claims issues, coordinating with the healthcare claims team. He/she coordinates interdepartmental reports and statistics in accordance with state agency requirements and acts as organizer, facilitator, and decision maker of associated work flows. Job Description 100% Remote Assists in planning and managing of the internal resolution unit with the health plan to ensure all operations meet the plan's overall objectives and contractual requirements. Develops procedures, selects, trains, and instructs staff. Coordinates work flows between Corporate claims, internal resolution staff, and applicable corporate departments. Tracks applicable correspondence and ensures compliance with state requirements. Leads staff in the investigation and resolution of claims issues, including incorrectly paid claims, by working with multiple operational areas and provider billings and analyzing the systems and processes involved in member enrollment, provider information management, benefits configuration and/or claims processing. Identifies the interdependencies of the resolution of claims errors on other activities within operations. Assists in the reviews of state or federal complaints related to claims. Coordinates the efforts of several internal departments to determine appropriate resolution of issues within strict timelines. Interacts with network providers and health plans regularly to manage customer expectations, communicate risks and status updates, and ensure issues are fully resolved. Investigates and resolves complaints from state agencies and customers, coordinating with internal departments as needed. Responsibilities Bachelor's degree in business or related field required. 5+ years' experience in claims and health plan operations required. 7+ years' supervisory experience required. 10+ years experience in claims and health plan operations in lieu of degree. Work Experience Work Experience - Required: Claims, Health Plans, Supervisory Work Experience - Preferred: Education Education - Required: A Combination of Education and Work Experience May Be Considered., Bachelors - Business Administration Education - Preferred: Certifications Certifications - Required: Certifications - Preferred: Potential pay for this position ranges from $85,570.00 - $145,470.00 based on experience and skills. Pay range may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (~~~/) and click on the "Benefits at a glance" button for more detail. Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law. Prime Therapeutics' fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members. If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people's lives. Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. ? If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at ~~~ or email ~~~.