Claims Manager

Delta Health Systems (DHS), one of the nation’s leading Third Party Administrators (TPAs) for self-funded health plans, is seeking an experienced and collaborative leader to join our team as Director of Operations. This position oversees day-to-day operational functions for our Stockton and Fresno offices and plays a key role in driving operational excellence, team development, and customer satisfaction.

Essential Duties and Responsibilities

• Supervise assigned staff in a responsible manner including training, planning, directing work, appraising performance, rewarding, and addresses complaints.
• Mentors, educates, and provides corrective action, performance improvement plans, and disciplines staff when necessary.
• Participants in the interview process for the hiring of new staff when necessary.
• Conducts monthly 1:1, quarterly, and annual performance reviews with staff to discuss productivity, issues, concerns, quality, and expectations.
• Responds to staff, internal and external customer inquiries, and provides resolution to issues accordingly.
• Evaluates department performance and takes corrective action, when necessary,
• Ensures overall inventory and assigned queues and processes are handled within department guidelines.
• Reviews department reports for accuracy, thoroughness, and timeliness and adjusts measurements when necessary.
• Interprets plan provisions and make recommendations for system administrative improvements to meet customer expectations.
• Develop relationships with other departments to ensure interdepartmental communication is effective.
• Develops and maintains effective relationships with customers and their affiliated partners.
• Manages within established budget of unit.
• Collaborates with information services on system enhancements, providing documentation and justification for improvements to system for proper claims flow.
• Assists Client Services with client requests to meet customer expectations, requests, and deadlines.
• Participate in new business implementations.
• Enforces, adheres to, and follows department policies and procedures and Collective Bargaining Agreements.
• Participates in and contributes to department meetings and continual training.
• Represents company at existing and prospective customer meetings.
• Upholds and exemplifies company values.
• Must occasionally travel to client locations.
• Performs other duties as assigned.

EDUCATION/EXPERIENCE/QUALIFICATIONS: Two to four years of management and claims experience. Must be computer literate w/proficiency in spreadsheet and word processing applications. Excellent written and verbal communication skills. Must have excellent leadership abilities and interpersonal skills; ability to establish confidence, rapport and foster cooperative relationships with clients, providers, and co-workers.  Must understand self-funded payer claims policies as well as Federal, State and other regulations pertaining to health insurance claims payment including TPL, COB, and coding and reimbursement methodologies.  Experience with automated claims systems; and ability to maintain sound production operations also required

SUPERVISION: This position reports directly to a Stockton Claims Manager,  limited supervision with considerable responsibility for work quality and quantity.