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Claims Manager, South San Francisco, CA


Health Plan of San Mateo

Manager

South San Francisco, CA

May 11, 2018


CLAIMS MANAGER

The Health Plan of San Mateo (HPSM), a managed care health plan, seeks a full time Claims Manager. This role will manage the functional operation of assigned claims activities. This may include claims processing, claims adjudication, or/and quality assurance.

The essential duties and responsibilities will include the following:

  • Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching, counseling, and implementing corrective action steps when necessary; developing, coordinating, and enforcing systems, policies, procedures, and productivity standards. Complete performance evaluations in a timely manner.
  • Develop strategies and schedules for meeting stated goals.
  • Continuously monitor and evaluate unit performance and take steps to improve the efficiency and quality of unit operations.
  • Create and update unit procedures, workflows, and resource material.
  • Effectively implement and maintain processes and workflows to meet the needs of internal and external customers.
  • Implement necessary policy and regulatory changes.
  • As required, develop and manage auditing and quality control processes.
  • Be available as a resource and functional area expert to other HPSM employees.
  • Analyze new or updated regulations, laws and contract language and implement appropriate changes to internal policies, procedures and workflows
  • Maintain knowledge of industry trends, best practices, and regulatory requirements.
  • Facilitate and document meetings.
  • Perform other duties as assigned.

Requirements

Education and Experience: Bachelor’s degree in business, finance or related field. Five (5) years of claims management experience with at least two (2) years in a supervisory role.

Knowledge of: Medi-Cal and Medicare programs. Personal computers and proficiency in Microsoft Office Suite applications, including Outlook, Word, Excel, and PowerPoint. Supervisory principles and practices as well as techniques and methods to organize and manage direct reports.

Ability to: Manage multiple priorities of a complex nature and meet deadlines. Motivate, guide and lead staff to excellence. Communicate effectively, verbally and in writing. Analyze and problem solve, making good decisions. Provide excellent customer service.

Starting Compensation: Depending on Experience

Benefits Information: Excellent benefits package offered, including HPSM paid premiums for employee’s coverage in the medical HMO plan and majority of PPO medical cost. Employee pays a small portion of the dependent premiums for medical and dental benefits. Additional HPSM benefits include fully paid vision, life, AD&D, STD, and LTD insurance; retirement plan (10% of salary for compensation/HPSM paid); holiday and vacation pay; tuition reimbursement plan; and more.

Application Process: To apply, submit a resume and cover letter with salary expectations to: Health Plan of San Mateo, Human Resources Department, 801 Gateway Blvd., Suite 100, South San Francisco, CA 94080 or via email: careers@hpsm.org or via fax: (650) 616-8039. File by: Continuous until filled. EOE

Submissions without a Cover Letter and salary expectations may not be considered.


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