Claims Systems Manager

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

📋 Description

• Offer strategic leadership and guidance to the Claims Systems Analyst Supervisor(s) and the Claims System Analyst team.

• Recruit, manage, assess, and mentor team members.

• 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.

• Provide daily updates to upper management as instructed by the VP of Business Services.

• Monitor, track, and escalate Business Requirement Documents, vendor contracts, and service desk ticket resolutions.

• Supervise and engage in software application selection, implementation, and upkeep.

• Distribute project and support-request resources based on organizational priorities and timelines.

• Compile project reports and documentation on project health and status.

• Develop and communicate the organizational vision and direction throughout the duration of projects.

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

• Define the vision, roadmap, and growth opportunities for the claims management system.

• Assess and prioritize the feature backlog and development requests.

• Manage vendor relationships and serve as an escalation point.

• Coordinate ISD teams to prioritize and deliver projects, reports, and enhancements within specified timeframes.

• Ensure that claims management technologies are utilized per policies and procedures.

• Utilize knowledge of North Carolina Medicaid rules and regulations.

⛳️ 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, particularly with claims or health insurance systems preferred.

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

• Extensive understanding 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.

• Knowledge 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.

• Exceptional written and verbal communication abilities.

• Strong analytical and problem-solving skills.

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

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

• Skilled in managing vendor relationships and employing conflict resolution techniques.

• Ability to define and implement strategic roadmaps that align with organizational objectives.

• Strong attention to detail with a commitment to accuracy and compliance.

• Quick and effective decision-making capabilities.

• Ability to build relationships with both internal and external stakeholders.

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

🏝️ 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 match.

• Company-paid life and disability insurance.

• Wellness Programs.

• Public Service Loan Forgiveness Qualifying Employer.