Manager Claims Systems - EviCore - Hybrid

The Manager of Claims Systems will own process design, tactical implementation and execution of strategies within the Claim Systems and Configuration teams through delegation or personal execution.

The position oversees the day-to-day operations with ultimate responsibility for the successful completion and quality of claims systems deliverables.

This position will perform duties under self-direction, have decision making responsibilities and act under the supervision of and assist the Sr Manager of Claims Systems, as needed.

Primary duties include, but are not limited to:


* Oversight of Claims Systems initiatives change control, risk assessment/management, impediment removal, as well as progress reporting to the Director of Claims Systems and/or other leadership, as required.


* Collaborate with the Claims Business Process Solutions, Claims Business Intake Team and Claims Product and Planning team for claims backlog governance workflow input, process improvement initiatives and resource impediments solutions.


* Provide input, as needed, toward LBC and OC discussions with Claims Leadership and Product and Planning resources.


* Through personal execution or delegation, ensure creation/maintenance of departmental work instructions, policies and workflows required to ensure success of deliverables and transition of knowledge to team members and other internal departments.


* Provide final approval of department work instructions, policies, workflows and training, as well as ensure audits are performed to verify adherence is met appropriately and timely.


* Motivate and guide the department to meet and exceed all goals and objectives as set forth by leadership.


* Support team Supervisors and Trainers regarding knowledge growth (i.e.

platform, program, process, etc.).


* Support team Supervisors in personnel activities (i.e., time and attendance, recruitment, annual performance evaluations, payroll, disciplinary procedures, training, etc.).


* Oversight of departmental audit control maintenance, adherence to audit controls and audit control artifacts are accessible upon request through collaboration with the Compliance team.


* Provide support to Claim Systems resources to overcome knowledge impediments or client escalations, which the Trainer and Supervisors are unable to overcome, through appropriate channels of support available both internally and externally.

Minimum Education, Licensure and Professional Certification requirement: Bachelor's degree in business, healthcare or computer related field

Minimum Experience Required:


* 5+ years of healthcare claims life cycle and client/vendor relationship experience, with an emphasis in healthcare claims system configuration/implementations.


* 2+ years of supervisor experience

Skills:


* Proficient in SQL Data Query, Excel, Word and Access, required


* Advanced in Excel and SQL, a plus


* SME of MC400 and RC3 systems, required
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