Job Title:Manager, Customer Service Operations - Claims
Location: Danville, PA
Department:Geisinger Health Plan
Work Type: Full Time
Responsible for management of Health Plan's Claims Operations, including the Commercial, Medicare, Medicaid, and TPA,. This responsibility includes oversight of achieving metrics, resource allocation, process improvement, coordinating training and ensuring policy development/updates related to claim functions. Administrative responsibilities include assisting administration in developing the team's annual operating budget, participating in and/or leading interdepartmental workgroups involved in strategic planning, developing and reviewing CST policies and procedures.
Reports to the Director, Claims Operations
COMPETENCIES AND SKILLS:
Demonstrates leadership skills with ability to work collaboratively to produce results across functional teams.
Demonstrates ability to develop and execute action plans to meet goals and objectives.
Demonstrates competence in written, oral, and electronic communication skills.
The specific statements shown above are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
EDUCATION AND/OR EXPERIENCE:
Bachelor's degree in Business, Health Care Administration or a related field required. (The appropriate mix of education and experience may be substituted for the degree). Minimum five years experience in managed care operations with management experience required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
Internal Number: 61729
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.