Manager Claims Administration

Job DescriptionWe 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 MedicaidSkills & 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 experienceAbout UsFounded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.