Vice President Health Plan Claims and Operations
Company: Prime Healthcare
Posted on: February 25, 2021
Vice President Health Plan Claims and Operations in Ontario,
California - Careers at PHMI Corporate Please Enable Cookies to
Continue Please enable cookies in your browser to experience all
the personalized features of this site, including the ability to
apply for a job. Welcome page Welcome page Returning Candidate? Log
back in! Vice President Health Plan Claims and Operations Facility
Prime Healthcare Management Inc Location US-CA-Ontario ID
2020-53418 Category Executive Position Type Full Time Shift Days
Responsibilities The Vice President of Health Plan Claims and
Operations--is responsible for the development and execution of
Claim Operations strategies, end-to-end Claim process automation,
optimization and management, identifying and leveraging technology
and data to improve the quality and minimize process cost of Claims
for all Prime Healthcare's self-insured Employee Health Plans.
Through in-depth audit and review of Claims data, the VP will
identify financial savings across all aspects of the Employee
Health Plans. The VP of Health Plan Claims and Operations--will
provide strategic leadership and development of the Claims
Department and its employees, as well as collaborate with Network
Development, Provider Affiliation and Member Relations,
Contracting, and Benefits Administration to ensure data integrity
and to drive financial and operational value across Employee Health
Plans to maximize benefit coverage while containing cost. The VP of
Health Plan Claims and Operations will partner with local C-Suites
and Hospital Administration to execute goals and plans of the
Employee Health Plans. Through inter-professional collaboration,
The VP will ensure that TPA and Health Plan are notified in a
timely fashion of any changes in process or procedures which would
impact their functions. #LI-CC1 Qualifications Required
- Master's Degree in Business Management, Healthcare
Administration, or other relevant fields.
- A minimum of seven (7) to ten (10) years prior work experience
in Claims Operations and Health Plan Strategy, in a Managed Care,
Self-Funded or hospital setting is required.
- Analytical skills with emphasis on generation and utilization
of data to drive operational and financial performance.
- Ability to work in a complex, rapidly evolving environment with
multiple internal and external entities and boundaries.
- Strong interpersonal skills, problem solving and project/time
- Ability to develop presentations to all levels using Microsoft
- Strong knowledge of medical coding (ICD-10, HCPCs/CPT, etc.)
- Certified Professional Coding Certification, AIC, ARM, or
- Familiarity with multiple Business Intelligence software
systems and daily usage of at least one. We are an Equal
Opportunity/ Affirmative Action Employer and do not discriminate
against applicants due to veteran status, disability, race, gender,
gender identity, sexual orientation or other protected
characteristics. If you need special accommodation for the
application process, please contact Human Resources. EEO is the
Options Apply for this job online Apply Share Email this job to a
friend Refer Sorry the Share function is not working properly at
this moment. Please refresh the page and try again later. Share on
your newsfeed Loading... Connect With Us! Not ready to apply?
Connect with us for general consideration.
Application FAQs Software Powered by iCIMS
Keywords: Prime Healthcare, Ontario , Vice President Health Plan Claims and Operations, Healthcare , Ontario, California
Didn't find what you're looking for? Search again!