Position Title:

/ Claims Processing Manager /

Company Division:

/ SS

Department:

/ Information Systems /

Position Type:

/ Full-time/Exempt

Reports to:

/ Kayloni Jeane
Director of Information Systems /

HR Contact:

/ Aimee’ Levy, MHA, SHRM-CP
EHNH Director of Human Resources

Position Description

Role and Responsibilities

Claims Processing Manager. The Claims Processing Manager’s role is to ensure accurate and efficient client implementation and ongoing claim management within the claims processing system as well as other related systems. This includes hands-on building and trouble-shooting clients within the claims processor, supervising a team of employees dedicated to building and maintaining clients within the systems, developing and maintaining processes and protocols, and working with developers and programmers to resolve issues. The Claims Processing Manager reports directly to the Director of Information Systems. The Employee is required to perform the following duties and undertake the following responsibilities in a professional manner.
·  Identify and learn appropriate software and hardware used and supported by the organization.
·  Plan and maintain work systems, policies, and procedures that enable and promote system integrity, efficiency, and compliance with client contracts.
·  Analyze claims processor system malfunctions or other problems and direct appropriate resolution to insure uninterrupted operations and compliance with client contracts.
·  Evaluate and document resolutions and analyze trends for ways to prevent future problems within the Claims Processing department.
·  Prioritize problems and schedule resolutions.
·  Develop help sheets and knowledge base articles for end users and employees.
·  Participate in phone calls and meetings with clients and other vendors to speak on behalf of the Claims Processing department and the company.
·  Maintain transparent communication through internal meetings and appropriate email, IM, and interpersonal communication.
·  Work with Human Resources and the Director of Information systems to recruit, interview, select, employ, and train an appropriate number of employees.
·  Coach, mentor, and develop staff.
·  Plan and allocate resources to effectively staff and accomplish the work to meet personal, departmental, and company goals.
·  Provide routine performance feedback and evaluations to employees, including recognition and disciplinary action, with the assistance of Human Resources when necessary.
·  Maintain employee training.
·  Implement, build, and maintain complete and detailed client profiles within the claims processor.
·  Field incoming help requests from end users or employees via telephone, email, IM, or tickets in a courteous manner.
·  Perform routine testing to ensure accurate problem resolution and development, compliance with client contracts, and system integrity.
·  Perform related duties consistent with the scope and intent of the position.

Required Skills and Competencies

·  Communication Proficiency.
·  Teamwork.
·  Technical Capacity.
Supervisory Responsibility
This position has no supervisory responsibility.

Position Type and Expected Hours of Work

This is a full-time, salaried position. Days and hours of work are Monday through Friday, 8:00 a.m. to 5:00 p.m., with occasional after-hours or weekend duties.

Travel

No travel expected for this.

Required Education and Experience

·  Bachelor’s degree in related field
·  Three to five years related experience, including working on a business analysis or software development project team
·  Experience in business analysis, working with business units to acquire and document business rules within a transaction based system
·  Demonstrated ability to positively interact with clients, internal customers and peers
·  Demonstrated willingness to take accountability for achieving service commitments and a demonstrated ability to achieve results
·  Strong proficiency with MS Office / Word, PowerPoint, Excel, and Outlook to create complex documents, manage schedules, and analyze data
·  Working knowledge of key business application such as SQL coding.
·  Excellent skills in written and oral communication, organization/prioritization, decision-making, problem analysis and resolution, negotiation, team building and leadership
·  Proven leader and team player
·  Driven and committed to overcome obstacles and successfully deliver the project on time and within budget
·  Delivery-focused, yet flexible and creative when called upon
·  Well-developed facilitation and collaboration skills
·  Thorough understanding of business process analysis, definition of business requirements and working knowledge of process mapping techniques.
· 

·  Preferred Education and Experience:

·  Pharmacy Benefit Management
·  Pharmacy Managed Care
· 
Reviewed By: / Kayloni Jeane / Date: / January 26, 2018
Approved By: / Dudley Cedars / Date: / Date
Last Updated By: / Aimee’ Levy / Date: / January 26, 2018

Employer’s Health Network Holdings, (EHNH) and all entities provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, EHNH complies with applicable state and local laws governing nondiscrimination in employment in every location in which the company has facilities. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

EHNH expressly prohibits any form of workplace harassment based on race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, genetic information, disability, or veteran status. Improper interference with the ability of EHNH employees to perform their job duties may result in discipline up to and including discharge.

Employee signature below constitutes employee’s understanding of the requirements, essential functions and duties of the position.

Employee Signature______Date______

Employee Printed Name______

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