Claims Systems Manager

This is a fully remote position, open to applicants in Florida, +5 more states.

📋 Description

• Provide strategic leadership and guidance to the team of Claims Systems Analyst Supervisors.

• Recruit, manage, assess, and mentor the Claims System Analyst team.

• Oversee workload and business needs to ensure sufficient staffing and productivity levels.

• Facilitate the design, development, implementation, and functioning of claims management and related software systems.

• Deliver daily status reports to senior management as instructed by the VP of Business Services.

• Monitor, track, and escalate Business Requirements Documents, vendor agreements, and service desk ticket resolutions.

• Supervise and engage in the selection, implementation, and upkeep of software applications.

• Allocate project and support resources in accordance with divisional and organizational priorities.

• Complete project documentation and reports on project health and progress.

• Develop and communicate the organizational vision and direction to the Claims System team and other stakeholders.

• Ensure that complex projects are in alignment with ISD architecture, infrastructure, and business objectives.

• Identify and articulate the vision, roadmap, and growth prospects for the claims management system.

• Evaluate and prioritize feature backlogs and development requests.

• Manage vendor relationships and serve as an escalation point for staff and stakeholders.

• Collaborate across ISD teams to prioritize and deliver projects, reports, and enhancements within specified timelines.

• Ensure compliance with policies and procedures in the use of claims management technologies.

• Utilize knowledge of North Carolina Medicaid rules and regulations.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or a closely related field.

• Seven (7) years of experience in managing data systems, with a focus on claims or health insurance systems preferred.

• At least five (5) years of experience in a management or supervisory capacity.

• Extensive knowledge of physical and behavioral health claims processing software systems.

• Familiarity with insurance principles, practices, federal and state regulations, and North Carolina Medicaid rules and laws.

• Understanding of project management methodologies and tools.

• Proficiency in business analysis techniques and tools, including the creation and management of Business Requirement Documents.

• Demonstrated ability to effectively lead and manage medium to large teams.

• Outstanding written and verbal communication skills.

• Strong analytical and problem-solving capabilities.

• Proficiency in claims management software, data analysis tools, project management software, Microsoft O365 suite, and service desk ticketing software.

• Capability to generate reports, pivot tables, and presentations.

• Ability to manage vendor relationships and employ conflict resolution techniques.

• Skill in defining and executing strategic roadmaps that align with organizational objectives.

• Attention to detail and a commitment to ensuring accuracy and compliance.

• Capacity to make informed decisions swiftly and effectively.

• Ability to build strong working relationships with internal and external stakeholders.

• Residency in Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia is required.

🏝️ Benefits

• Annual incentive bonus plan.

• Medical, dental, and vision insurance with a low deductible/low-cost health plan.

• Generous accrual of vacation and sick time.

• 13 paid holidays.

• State Retirement (pension plan).

• 401(k) Plan with employer matching.

• Company-paid life and disability insurance.

• Wellness Programs.

• Qualifying Employer for Public Service Loan Forgiveness.