Manager of Claims - Healthplan job in Houston

Work in this growing health plan organization in a management role overseeing the staff which coordinate with and have delegation oversight of claims operations as well as benefit and policy configuration. This includes monitoring all aspects of claims production to ensure accuracy, production, and regulatory requirements are met and to ensure the accuracy of configured benefits and policies within the operating system.

To qualify for this opening, you should have a Bachelors in Heathcare or equivalent experience, 5+ years managing healthcare claims or managed care claims in Commercial and Medicare areas, have experience with all laws and criteria required for working with ERISA, Department of Labor, HIPAA, TDI, Centers for Medicare and Medicaid Services and URAC. Knowledge of provider network arrangements and reimbursement methodologies and of health benefit plan concepts. Conversant with standard electronic and paper claim formats; familiarity with American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) coding guidelines such as the National Correct Coding Initiative (NCCI) edits and their relation to clinical logic in claims adjudication. You will report to the head of Third Party Administration.