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Manager Claims Administration at Texas Children's Careers
Houston, Texas, United States -
Full Time

Start Date

Immediate

Expiry Date

18 Jan, 26

Salary

0.0

Posted On

20 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

No

Skills

Claims Processing, Policy Development, Mentoring, Regulatory Compliance, Health Care Environment, Claims Adjustments, Appeals Management, Correspondence Management, Performance Goals, Staff Development, Texas Medicaid, Insurance Regulations, Integrated Delivery Systems, Process Implementation, Organizational Skills, Timeliness

Industry

Hospitals and Health Care

Description
We are searching for a Manager of Claims Administration — someone who works well in a fast-paced setting. In this position, you will plan, develop, and implement Claims Processing functions and related processes for the Claims Administration Department. Think you’ve got what it takes? Job Duties & Responsibilities • Plan, develop, organize, and implement processes to ensure timely and accurate claims processing. • Plan, develop, organize, and implement processes to ensure claim adjustments, appeals and correspondence is completed timely and accurately. • Develop policies and procedures and systems for a Pediatric MCO based on the integrated delivery system goals and objectives and which meet the performance goals and measurements. • Mentor and develop Claims Processing staff toward expansion of job roles to meet the continuous challenges and changes of the health care environment, contracts and governmental regulations, including promoting the ability to respond effectively to innovative initiatives. • Review and implement Texas Department of Insurance regulations pertaining to HMOs • Review and implement HHSC statutory reporting requirements of Texas Medicaid Skills & Requirements • High School Diploma or equivalent • 7 years of Health Plan Claims Administration or related experience • Bachelor’s degree will substitute for four (4) years of experience
Responsibilities
The Manager of Claims Administration will plan, develop, and implement processes to ensure timely and accurate claims processing. This role also involves mentoring staff and ensuring compliance with relevant regulations.