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Director of Claims and Enrollment Operations

extra holidays - extra parental leave

Remote:

Full Remote

Experience:

Senior (5-10 years)

Work from:

Oregon (USA), United States

Offer summary

Qualifications:

Bachelor’s degree in Healthcare Administration or Business Administration., Master’s degree preferred., Five years experience in healthcare claims processing., Three years leadership experience required..

Key responsabilities:

Oversee strategic operations of Claims and Enrollment departments.
Ensure compliance and drive improvements in processes.

Samaritan Health Services XLarge https://www.samhealth.org/

5001 - 10000 Employees

See all jobs

Job description

Samaritan Health Plans (SHP) provides health insurance options to Samaritan employees, community employers, and Medicare and Medicaid members. SHP operates a portfolio of health plan products under several different legal structures: InterCommunityHealth Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; SHP is also the third-party administrator for Samaritan Health Services’ self-funded employee health benefit plan.

As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services’ mission of Building Healthier Communities Together.

Occasionally

We are open to remote out of state work in any of our approved states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin
JOB SUMMARY/PURPOSE
Oversees and manages the strategic operations of the Claims, Enrollment, and Provider Data Management departments. Ensures the accuracy, efficiency, and compliance of all related processes, driving improvements and innovations to support organizational goals. Works closely with internal and external stakeholders to ensure service excellence, operational efficiency, and regulatory compliance.
EXPERIENCE/EDUCATION/QUALIFICATIONS
Bachelor’s degree in Healthcare Administration, Business Administration, or a related field; or equivalent experience required. Master’s degree preferred.
Five (5) years of experience in claims processing, enrollment, and provider data management within a managed care organization or a similar healthcare setting required.
Three (3) years leadership experience required.
Experience with healthcare regulations, including Medicare and Medicaid, required.
Experience in healthcare management systems and data analytics tools required.
KNOWLEDGE/SKILLS/ABILITIES
Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.
Conflict resolution - Influences others to build consensus and gain cooperation. Proactively resolves conflicts in a positive and constructive manner.
Critical thinking – Identifies complex problems. Involves key parties, gathers pertinent data and considers various options in decision making process. Develops, evaluates and implements effective solutions.
Communication and team building – Leads effectively with excellent verbal and written communication. Delegates and initiates/manages cross-functional teams and multi-disciplinary projects.
PHYSICAL DEMANDS
Rarely (1 - 10% of the time)

(11 - 33% of the time)

Frequently

(34 - 66% of the time)

Continually

(67 – 100% of the time)

LIFT (Floor to Waist: 0"-36") 0-20 Lbs

LIFT (Knee to chest: 24"-54") 0 - 20 Lbs

LIFT (Waist to Eye: up to 54") 0 - 20 Lbs

CARRY 1-handed, 0 - 20 pounds

CARRY 2-handed, 0 - 20 pounds

KNEEL (on knees)

BEND FORWARD at waist

CLIMB - STAIRS

STAND

WALK - LEVEL SURFACE

ROTATE TRUNK Standing

REACH - Upward

PUSH (0-20 pounds force)

PULL (0-20 pounds force)

SIT

ROTATE TRUNK Sitting

REACH - Forward

MANUAL DEXTERITY Hands/wrists

FINGER DEXTERITY

PINCH Fingers

GRASP Hand/Fist

None specified

PI255228179