Health Care Claims Adjudicator

HEALTH CARE CLAIMS ADJUDICATOR

DURATION: 12-month contract (W2) - may convert to FTE; only want candidates interested in permanent role

LOCATION: Oakland, CA 94612

JOB NUMBER: 59434

CLIENT: One of the country's largest health care and health plan providers

NUMBER OF PEOPLE SUPERVISED: roughly 20

TRAVEL: there may be a need to travel to Southern California

JOB DESCRIPTION:

- Responsible for the operations of one or more claims processing units, including timely and proper adjudication of claims in accordance with contractual benefits
- Responsible for providing leadership and direction to employees
- Directs the processing of insurance claims to meet operation, financial, and service requirements
- Develops and executes strategic and operational business plans for the departments
- Coordinates department operations and modifications with other areas of the organization
- Works on issues of broad scope
- Receives assignments as objectives with the processes necessary to fulfil those goals
- Requires considerable planning and direction setting
- Develops and directs work schedules and monitors work flow to achieve established goals and objectives
- Responsible for recommending changes in guidelines, procedures, and policies.

TOP DAILY RESPONSIBILITIES:

- Responsible for providing leadership and direction to employees
- Directs the processing of insurance claims to meet operation, financial, and service requirements
- Coordinates department operations and modifications with other areas of the organization
- Responsible for the operations of one or more claims processing units, including timely and proper processing of mail and the associated document management activities

REQUIRED EDUCATION, EXPERIENCE, AND SKILLS:

- Bachelor's degree in business administration, OR four (4) years of experience in a directly related field
- High School Diploma or General Education Development (GED) required
- Minimum 3 years' claims processing experience
- 3-5 years' experience supervising a large team of non-exempt staff members

SOFT SKILLS:

- Adaptability
- problem solving
- interpersonal communication
- analysis of data
- process controls
- people management skills
- leadership
- commitment to excellence
- collaborative