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Employment Type:

Full time

Shift:

Description:

Why MediGold?

MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

We know that exceptional patient care starts with taking care of our colleagues, so we invest in great people and all that we ask in return is that you come to work ready to make a difference and do the right thing.

What we offer:

• Competitive compensation and benefits packages including medical, dental, and vision coverage
• Retirement savings account with employer match starting on day one
• Generous paid time off programs
• Employee recognition incentive program
• Tuition/professional development reimbursement
• Relocation assistance (geographic restrictions apply)
• Discounted tuition and enrollment opportunities at the Mount Carmel College of Nursing

Why Columbus?

The nation's 14th largest city, Columbus, Ohio is one of the fastest growing major metropolitan areas in the Midwest – ranked #1 for population growth, #1 for job growth, #1 for wage growth, and #1 real estate market. And with a vibrant blend of professional sports, world-class attractions, creative cuisines, and a flourishing music and arts scene, you'll never be found wanting for entertainment and experiences to call your own in Columbus. Learn more at www.experiencecolumbus.com!

About the job:

The Manager Claims Operations manages the daily operations for claims review and processing functions.

What you'll do:

• Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization.
• Manages staff relations including performance management, staff satisfaction, and conflict management. Performs and oversees scheduling, recruitment, payroll, and student engagements.
• Monitors departmental budgets, regulatory compliance, departmental contracts, and vendor relations. Determines and justifies needs for systems/equipment/supplies purchases, monitors usage, and oversees proper working order and/or stock supplies.
• Supports special projects and business analysis as requested.
• Serves as the main point of contact and as the Claims subject matter expert (SME) for internal and external auditors.
• Conducts audits, monitors daily performance of department and vendors and provides immediate feedback to colleagues and supervisor.
• Takes a proactive approach when issues are identified by presenting potential solutions to upper management to resolve issues
• Serves as primary trainer for the Claims department through developing and directing ongoing training programs.
• Attends educational meeting/programs to maintain and expand current knowledge regarding Medicare Advantage and related job responsibilities.

What we're looking for:

• Minimum Education Requirement: Bachelor's Degree or equivalent combination of education and experience.:
• Licensure Requirement: CPC or equivalent certification preferred
• 7 or more years of relevant work experience including experience in leadership roles.
• Knowledge of Medicare and Medicare Advantage
• Ability to critically think and diffuse potential problematic situations
• Strong personal presence that is characterized by a sense of honesty and integrity.
• Demonstrated ability to understand and meet all technical, educational and operational needs of a Service Center.
• Experience developing, executing, measuring and monitoring and continuous service performance improvement initiatives to targeted outcomes.
• Must be proficient with all Microsoft Office automation software and knowledge of the claims platform and ancillary applications.
• Works independently and requires high level of judgment and discretion
• Demonstrates high tolerance for ambiguity and change while providing leadership to department staff to adapt effectively to meet changing environment

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Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, physical disability or any other classification protected under local, state or federal law.

Our Commitment to Diversity and Inclusion