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Claims Operations Director

ASSOCIATION HEALTH CARE MANAGEMENT
Dallas, TX
  • Posted: over a month ago
  • $90,000 to $110,000 Yearly
  • Full-Time
  • Benefits: dental, life insurance, medical, vision, 401k,
Job Description

Association Health Care Management is seeking an experienced Claims Operations Director in Adjudicating Claims to join our team in Dallas, TX!

Competitive Pay & Benefits

MUST have TPA experience

A Great Company Culture & Team Atmosphere That is Alive and Unique!

Please submit your application via Indeed for immediate consideration.

We Offer

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Paid training
  • Vision insurance
  • 1 hour lunch break
  • PTO
  • Great Company Culture
  • Bi-Weekly Incentives
  • Career Mobility

Duties & Responsibilities

  • Direct the Claims team to include selection, training/development, coaching, counseling, and performance management
  • Establish and successfully communicate Claims department goals and objectives together with managers and supervisors set goals and expectations; perform associate evaluations and provide coaching as appropriate
  • Implement processes to ensure timely and accurate processing of claims
  • Manage claims process including reconciling and auditing of claims submitted
  • Provide statistical analysis of claims flow and production results
  • Provide client service and technical support, including data analysis, troubleshooting, and issue resolution
  • Identify and develop enhancements to the claims process, including scanning, vertexing, workflows, system software, etc.
  • Develop and manage corrective action and quality improvement plans
  • Ensure full compliance for all accreditations and governmental ratings
  • Oversee specialty accounts management
  • Special projects as assigned or necessary
  • Maintain departmental documentation, internal and external certifications

Qualifications

  • Preferred Bachelor's degree in related field or equivalent combination of experience and education
  • Minimum of 2 to 5 years management experience to include claims processing, managing teams, setting goals/expectations, timeline driven outcomes, and implementation of sustainable strategic solutions
  • Thorough knowledge of health care insurance as might be shown by a minimum of 2 - 5 years at an insurance company
  • Proficiency in Microsoft Office
Company Description
Association Health Care Management, Inc. established in 1983 has always maintained our own TPA license, giving us an advantage when dealing with complex healthcare systems. With this, we have helped project managers, insurance companies, benefit providers, and associations develop and implement various healthcare solutions.

Our goal is to provide powerful healthcare management solutions in a rapidly changing industry. We help leaders solve their organization’s most critical problems and opportunities. Together we create lasting change with significantresults.

ASSOCIATION HEALTH CARE MANAGEMENT

Why Work Here?
Great Company Culture that is alive and Unique

Association Health Care Management, Inc. established in 1983 has always maintained our own TPA license, giving us an advantage when dealing with complex healthcare systems. With this, we have helped project managers, insurance companies, benefit providers, and associations develop and implement various healthcare solutions. Our goal is to provide powerful healthcare management solutions in a rapidly changing industry. We help leaders solve their organization’s most critical problems and opportunities. Together we create lasting change with significantresults.

Address

Dallas, TX
USA

Industry

Finance and Insurance

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