Claims Systems Manager

Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 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

See attachment for additional details.

Office Location: Remote option; Must live in one of the following states: Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia

Projected Hiring Range: $99,963.31 - $129,952.29 (DOE)

Closing Date: Open until filled

Primary Purpose of Position:

The Claims System Manager will provide strategic leadership and oversight to a team of Systems Analysts responsible for managing and monitoring Vaya Partners claims management system and supporting applications. Operating within the Information Services division and collaborating with cross-functional teams, the Claims System Manager will play a pivotal role in defining and implementing the strategic roadmap for Vaya Partners Claims Management software application, ensuring alignment with the organization's overall strategic plan and mission, vision, and values.

Key responsibilities include overseeing and managing staff and vendors responsible for system configuration, development, implementation, maintenance, and technical support. This role requires extensive interaction with internal and external stakeholders to address all aspects of claims processing and resolve any issues or concerns.

Additional responsibilities encompass the oversight of Business Requirement Documents (BRDs), vendor contracts, and service desk ticket resolution, all while adhering to organizational policies and contractual requirements. This position also involves escalating items that are behind schedule or pose a risk to the organization if not complete. The successful candidate will be detail-oriented, capable of providing regular status updates to stakeholders, and ensuring timely resolution of all assignments and issues. The Claims System Manager will work closely with cross-functional teams to address escalations promptly and effectively, striving for streamlined, efficient solutions that align with organizational objectives. This position will ensure that software technologies related to Vaya Partners claims management system and associated applications are used in accordance with current policies and procedures and will be familiar with North Carolina Medicaid rules and regulations.

Role and Responsibilities:

20% Administrative Supervision and Functions

• Directs and provides oversight to the Claims Systems Analyst Supervisor(s) team including but not limited to:
  • Ensuring supervision and administrative functions are addressed per policy and in a timely manner such as the hiring, supervising, evaluating, and mentoring the Claims System Analyst team.
• Monitors current workload and business requirements for the purpose of maintaining adequate staffing, enhancing productivity of personnel.
• Facilitate the design, development, implementation, and operation of the claims management and associated software systems.
• Provides daily status updates to upper management as directed by the VP of Business Services
• Monitors, tracks, and escalates the status of Business Requirements Documents (BRDs), vendor contracts, and ticket resolution. This includes maintaining detailed records and providing regular status updates to appropriate stakeholders.

35% Project Oversight/Guidance

• Provides oversight and participates in the selection, implementation, and maintenance of software applications.
• Working within Vaya Partners Project Management policy and guidelines, allocates resources for projects and support requests, ensuring priorities are aligned with divisional and organizational priorities while meeting stated deadlines.
• Complete required project reports and documentation to ensure organizational leadership and project stakeholders are aware of a project’s health and status on a regular basis
• In conjunction with the PMO team, ISD leadership and others, develop and communicate organizational vision and direction to Claims System team and stakeholders throughout projects.
• Working with the Cloud and Infrastructure Director, IT Change Control Administrator, and others when applicable, ensuring assigned complex projects aligned with ISD architecture, infrastructure, and business goals.
• Ensures timely resolution of issues related to BRDs, vendor contracts, and ticket resolution by collaborating with cross-functional teams to address any escalations promptly and effectively.

40% Systems Management and Business Support

• Identifies and defines vision, roadmap, and growth opportunities for the claims management system that aligns with divisional and organizational strategic initiatives.
• Routinely evaluates and prioritizes the feature backlog and development requests, ensuring required functionality is placed into production within the constraints of the business
• Manage vendor relationships and act as a point of escalation for staff and stakeholders.
• Provide support and coordination between all ISD teams members to ensure projects, reports, and enhancements are prioritized correctly and developed within stated timeframes.
• Track and escalate issues related to vendor contracts and ticket resolution to ensure all processes are streamlined and aligned with organizational objectives.

Knowledge, Skills and Abilities:

Knowledge

• In-depth understanding of physical and behavioral health claims processing software systems
• Knowledge of insurance principles, practices, federal and state regulations Medicaid rules, with specific experience in North Carolina Medicaid laws
• Understanding of project management methodologies and tools
• Knowledge of business analysis techniques and tools, including the creation and management of Business Requirement Documents

Skills

• Proven ability to lead and manage medium to large teams effectively
• Exceptional written and verbal communication skills, comfortable engaging with all levels and types of stakeholders
• Excellent analytical and problem-solving skills to address system issues and identification of process improvements
• Proficient in using claims management software, data analysis tools and other relevant technologies including but not limited to project management software, Microsoft O365 suite of applications, service desk ticketing software, etc.
• Able to create reports, pivot tables, presentations as required by business needs
• Ability to manage vendor relationships, using conflict resolution methods to address risks or issues

Abilities

• Able to define and implement strategic roadmaps that align with organizational goals
• Capacity to thrive in a dynamic and evolving environment
• Keen attention to details, ensuring accuracy and compliance in all assignments and responsibilities
• Ability to make informed decisions quickly and effectively, especially in high demand situations
• Cultivate working relationships with internal and external stakeholders to resolve issues and improve processes

Education and Experience Required:

• A Bachelor’s degree in Business Administration, Information Systems Management, Health Information Management, or closely related field; AND seven (7) years of experience in management of data systems, focus on claims or health insurance systems a plus.
• A minimum of five (5) years experience in a management/supervisory role.

Education and Experience Preferred: N/A

Licensure/Certification Requirements: N/A

Originally posted on Himalayas