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Sanford Health Manager, Claims - Health Plan in Sioux Falls, South Dakota

Job Title: Manager, Claims | Health Plan | Sioux Falls

City: Sioux Falls

State: SD

Department : Claims - Sioux Falls

Job Schedule: Full Time

Shift: Varies

Hours Per Shift: 8 hr

JOB SUMMARY

The Claims Manager is under the general supervision of the Sanford Health Plan Director of Claims, in the areas of health insurance claims submitted by providers and patients for processing.

Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and fee schedules to ensure claims process correctly. Accountable as a resource to all employees in the claims department as well as other departments in the organization. Responsible for the interviewing, hiring, discipline of employees and any other personnel issues that arise. Completes performance appraisals. Coordinates claims processing and adjustment activities within the claims department. Manages claims inventory, ensuring accurate and timely processing. Knowledge of various lines of business that the Sanford Health Plan services and how to differentiate services. Understands the details of professional and institutional claim processing which includes how benefits are assigned and pricing is calculated. Works to help develop and maintain claims policies and procedures. Must communicate effectively with a high level of diplomacy. Demonstrates analytical ability and a good awareness of pertinent details. Assimilates large amounts of information to maintain a broad knowledge base. Exercises good judgement in determining the best method for handling a variety of situations. Maintains good working relationships with staff, physicians, and enrollees. Handles pressure effectively. Maintains confidentiality. Other duties as assigned.

POSITION RESPONSIBILITIES

Collaborates with internal and external experts to pursue complex business opportunities and achieve business goals. Promotes a climate that encourages self-motivation, self-management and continued personal development. Creates a team environment of accountability and commitment for reaching project goals. Coordinates multiple types of claims and auxiliary functions. Recognizes, clarifies, and prioritizes concerns. Selects suitably diverse candidates through resume screening, interviews or other methods. Generates and interprets a wide range of statistical data and reports. Streamlines the critical workflow for executing key processes. Motivates others to work toward a common purpose. Delivers written and oral communication, responds to questions and concerns, and produce specific outcomes and impact.

QUALIFICATIONS

Bachelor's degree preferred.

Three years in a team lead or management role in claims processing or similar environment required.

About Sanford Health:

At Sanford Health, we are dedicated to the work of health and healing.

Every day, we show that commitment by delivering the highest quality of care to the communities we serve.

We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.

In addition to strong clinical care, we are also committed to research, education and community growth.

We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.

We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.

The entire team at Sanford Health recognizes the value of healthy families and communities.

We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application,

please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

City: Sioux Falls

State: SD

Job Function: Health Plan

Job Schedule: Full Time

Shift: Varies

Req Number: WD09227

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