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Director of Claims, Salem, OR

Organization: ATRIO Health Plans
Category: Director
Location: Salem, OR
Date Job Posted: September 2, 2020
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At ATRIO, our mission is to improve health outcomes for our members and the communities we serve. We welcome dedicated, passionate, and innovative leaders who are ready to make a difference. We offer the opportunity to work in a rewarding, team-oriented environment, to earn a competitive salary and enjoy excellent benefits. We value talent, experience and a strong work ethic, but also place a premium on individuality, creative thinking and a strong sense of community.

We are currently seeking a Director of Claims. This is a salaried, exempt position in Salem, OR.

Position Summary: The Director of Claims is responsible for benefit configuration and oversight of ATRIOs Third Party Vendor, specific to claims. This position will oversee the monitoring process prior to claims adjudication and monitor claims weekly. This position will also work closely with the Director of Provider Relations and Contracting to ensure provider configuration is set up accurately for claims processing. This position is responsible for research, investigation, and resolution of all types of claims questions.

Reporting Accountability: This position reports to the Chief Operations Officer

Primary Role and Responsibilities:

  • Develop and implement operating procedures, policies, and performance plans; design and review reports that track claims statistics including claims inventory, and report on production and quality assurance goals
  • Coordinate claims system vendors, clients and appropriate internal and client departments to resolve claims issues
  • Provide claims subject matter expertise to internal work groups and systems initiatives; participate in testing and implementation of claims processing technology changes and enhancements
  • Provide management level review of claims, COB, eligibility, provider configuration, and medical, vision and dental contract benefits
  • Oversee and guide claims payment processes, assuring appropriate communication with key stake holders
  • Assist customer service in answering complex claims questions
  • Oversee and test benefit configurations and contract changes for proper claims adjudication
  • Identify and report any irregularities or trends in claims processing
  • Understand Payment methodologies specific to claims processing: IPPS, OPPS, ASC, SNF, ESRD, RBRVS, and flat rates and compare with claims processing
  • Respond to provider inquires specific to claims processing
  • Educate and train customer service staff regularly on claims processing rules and CMS Policies
  • Establish goals for staff and monitor performance to ensure goals are met, complete formal performance appraisals, and recommend pay changes
  • Review and monitor tasks done by staff to ensure that work is done according to procedures, methods, and work plans
  • Instruct staff on how to do work and help them with difficult problems; and ensure that staff receives appropriate training as needed to perform their work; design mentorship programs to increase the overall level of expertise and proficiency of staff
  • Conduct hiring and termination process; approve time off, monitor attendance and sign time sheets
  • Assist with budget preparation and staffing needs assessments
  • Perform claims functions when necessary due to staff availability constraints
  • Other duties as assigned

Professional competencies:

  • Knowledge of the principles, practices and techniques of health insurance laws and regulations of health insurance and Medicare claims processing
  • Strong knowledge of ATRIO plans, customer and provider needs, and customer service skills
  • Ability to manage staff and multiple competing deadlines
  • Advanced level experience with Microsoft Office products
  • Proficiency in the use of standard office equipment
  • Exhibit strong organization skills
  • Work self-sufficiently and be self-directed
  • Display practical judgment
  • Interface effectively between staff, management and executive levels
  • Communicate decisions diplomatically
  • Work with a high level of accuracy and attention to detail

Preferred Experience:

  • 5-8 years of related health plan claims experience or equivalent management experience.
  • Demonstration of progressive roles with greater responsibility

Preferred Education and Training:

Bachelor’s Degree in business, healthcare administration, or equivalent degree or certification preferred.

Here are just a handful of the benefits our employees enjoy:

Company benefits

  • Health Insurance: We offer our employees the choice of a comprehensive PPO plan or HSA plan that covers the employee, their partners and families.
  • Dental Insurance: We have two dental coverages for our employees to choose from. Employee premiums are covered at no cost to the employee.
  • Vision Insurance: Our vision insurance premiums are covered at no cost to the employee for coverage of their family.
  • 401(k) plan: Our employees are eligible to contribute after 90 days of employment. Company match also applies.
  • Life and ADD Insurance: Premiums for base coverage for our employees are covered.

We also offer our employees benefits that help lead to a better work-life balance

  • Charity Matching Donation: We match donations made from our employees to charities of their choice and also provide up to two full days off paid for volunteer work.
  • Tuition Reimbursement: We offer our employees a tuition reimbursement program for them to further educate and improve themselves in their field.
  • Gym Membership Reimbursement: We provide a supplemental reimbursement for our employees who belong to a gym.
  • Paid Time Off: Our employees start accruing paid time off on their first day of hire. In addition, employees receive a personal day off, and seven paid holidays.

ATRIO is an equal opportunity, affirmative action Company committed to cultural diversity and compliance with the ADA. ATRIO encourages all qualified individuals to apply, and does not discriminate on the basis of any protected status, including veteran and disability status.

Please send resume and cover letter to attention Joel Kuhl.

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