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Career Opportunities: Claims Manager (24640) Requisition ID 24640 - Posted 10/18/2024 - CareOregon - Full Time - Permanent - Portland - Multi Location (10) Job Description Print Preview Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Claims Manager Department Claims Exemption Status Exempt Requisition # 24640 Direct Reports Claims Department Staff Manager Title Director, Operations Pay & Benefits Estimated hiring range $88,430 - $108,080 /year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefits Posting Notes This role is fully remote but must reside in one of the listed 9 states. Job Summary The Claims Manager is responsible for leading best practices and daily operations of the Claims department that spans multiple lines of business and types of claims. Responsibilities include ensuring oversight of claims management, vendor relationships, and the implementation of technological best practices to improve the department's capabilities to meet the needs of members. The position provides leadership and development opportunities for the Claims team and ensures that CareOregon standards and all applicable contract requirements are met or exceeded. Essential Responsibilities Manage the operations of the Claims department to ensure the department meets productivity and quality standards and promotes efficiencies through automation and cost containment efforts. Ensure strict adherence to Medicare, Medicaid, MSA, ASO and Plan contract requirements. Collaborate with IS, Audit and Compliance, Provider Services, Medical Management and Line of Business leaders and staff to ensure effective integration across teams. Partner with CareOregon departments, lines of business, programs, providers and partners. Ensure the timely and accurate processing of claims and adjustments. Support payment integrity program initiatives. Promote CareOregon values, particularly in the areas of customer service, change management, leadership, performance levels and results orientation. Champion organizational goals related to Medicare Star Ratings, Coordinated Care Organization (CCO) metrics, compliance and other initiatives. Recommend and implement changes in guidelines, procedures and policies to comply with changes in federal regulatory requirements or improve efficiencies and performance. Implement claims strategies related to Medicare/Medicaid and any applicable line of business. Analyze available information to find opportunities for operational improvements and ways to help employees perform at their best. Provide accountability for service level goals and performance guarantees. Serve as the claims liaison for internal and external audits and reviews. Manage vendor relationships as they relate to functions of the department. Develop and communicate weekly inventory of Service Level Agreement (SLA) misses along with root cause analyses and mitigation plans. Develop, manage and report on any inventory backlog reduction plans. Participate in and lead projects related to claims processing as needed. Develop presentations and present claims-related information as needed. Employee Supervision Direct teams and establish team direction and goals in alignment with the organizational mission, vision, and values. Identify work and staffing models; recruits, hires, and oversees a team to meet work needs, using an equity, diversity, and inclusion lens. Identify department priorities; ensure employees have inform