The posting
Job Description
POSITION PURPOSE:
- Demonstrate a commitment to the Corporate and Department mission and vision.
- Manage and monitor the expedient and accurate adjudication of claims and adjustments and/or refunds.
- Organize and oversee the overall resolution of written and verbal inquiries from internal and external members.
- Provide the guidance, motivation, and support necessary to enable individual growth and team work in line with the individual needs, department objectives, and marketplace expectations.
ACCOUNTABILITIES:
- Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
- Ensure, direct, and/or provide the training of staff, both permanent and temporary to the Claims Department
- Promote teamwork and encourage high levels of morale and motivation.
- Create high performance work teams through the use of performance measurements, individual goal setting, and monitoring and evaluation of results.
- Work with staff to develop and implement goals and objectives both individual and for the department.
- Motivate staff to meet/exceed department quality and production expectations
- Identify staff performance issues and prepare and implement action plans to resolve problems
- Work with Technical Support Coordinators to determine level of claims requiring auditing for each examiner.
REQUIRED QUALIFICATIONS:
- Bachelor’s Degree in management, business, health care, human relations, or related area, or Associate Degree with at least 2 years of leadership/management experience. Education may be waived with a minimum of 4 years of leadership/management experience.
- Detailed understanding of the health care industry, including internal operations of insurers and provider network arrangements.
- Ability to interact with all levels of HealthPartners staff and external customers
- Must be able to establish and maintain effective, courteous and confidential relationships with staff, providers, and members.
- Strong interpersonal and human relations skills.
- Work independently and as a team member.
- Ability to lead others through change and to be flexible and adaptive to changes; ability to make immediate adjustments to work direction.
- Provide an environment that fosters enthusiasm; pride in the job, and commitment to the goals and visions of HealthPartners.
- Establish a working environment free from harassment and discrimination.
- Demonstrate effectiveness in evaluation employees and giving feedback.
- Ability to identify training needs and provide learning opportunities.
- Ability to make verbal presentation and lead discussions
- Advanced analytical skills and problem solving ability.
- Experience in interpretation and implementation of technical data and contracts.
- Proven logical and principle-based decision making, and ability to meet deadlines.
- Strong organizational and time management skills.
- Working knowledge of CQI process and principles.
- Computer knowledge.
- General knowledge of accounting principles
PREFERRED QUALIFICATIONS:
- Bachelor’s Degree in management, business, health care, human relations, or related area, or Associate Degree with at least 4 years of supervisory experience in a health care setting.
- 2-4 years HealthPartners claims experience and familiarity with the goals and objectives of HealthPartners.
- Experience processing claims and a general knowledge of various processing systems.
- Working knowledge of Collective Bargaining Agreements.
- Project management experience.
DECISION-MAKING:
Must have the ability to work and make logical decisions independently in a fast-paced continuously changing environment. Has latitude in the allocation of work team to meet customer service objectives. Decisions, which affect the entire department, should be communicated with appropriate team members.
About Us
At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Benefits Designed to Support Your Total Health As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.
Join us in our mission to improve the health and well-being of our patients, members, and communities.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
