Claims Manager

Who you are:

As the Claims Manager for Johns Hopkins HealthCare, you are responsible for planning, managing and organizing functions of the claims department. You are the conduit between the health plan(s) and our external vendor(s) and have ownership of the vendor performance metrics related to claims processing and scanning.

What you’ll do:

• You are responsible for ensuring the department meets all contractual and regulatory SLAs for all lines of business.
• Vendor oversight to include but not limited to ensuring they meet quality and production expectations
• You will collect, compile, and analyze data that is used to make business and operational decisions
  • Identify areas for process improvement to include evaluation and implementation of possible solutions
• Lead a team of analysts and processors to accurately process claims, adjustments, and other back office procedures in a timely fashion
• Collaborate with internal and external stakeholders to resolve complex claims issues and escalations

What you’ll bring:

• 5+ years’ experience in medical claims processing in a health plan environment
  • 3+ years’ progressive experience in leadership role
• 2+ years in a reporting or process improvement role in a health care setting
• Strong level ability with Excel.
• Ability to use SQL query language is highly preferred
• Ability to take claim payment problems and translate those into queries to identify all inaccurately processed claims for correction and re-processing.
• Must possess the ability to draw accurate and timely conclusions and be able to communicate them effectively to management, other staff members and external clients while being sensitive to the contractual and client relationships at stake.
• Requires an understanding of health plan and managed care operations. Knowledge and in-depth understanding of claim system configuration, fee schedules, and provider set-up is required.
• Bachelor’s degree in health plan management, business, computer science, or similar field highly preferred

Who we are:

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.

Please note: US citizenship is required for this position as it falls under the terms of a government contract (to ensure compliance with DODPSP).

This position is eligible for remote work.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.