Vice President of Claims 8/27/2016

Meridian Health Plan Detroit, MI

Company
Meridian Health Plan
Job Classification
Full Time
Company Ref #
29313634
AJE Ref #
576001178
Location
Detroit, MI
Job Type
Regular

JOB DESCRIPTION

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WHO WE ARE:

Meridian Health Plan is a family-owned, family-operated company of passionate leaders, achievers, and innovators dedicated to making a difference in the lives of our members, our providers and in the healthcare industry.

We provide government-based health plans (Medicare, Medicaid, and the Health Insurance Marketplace) in six different states (Michigan, Illinois, Indiana, Kentucky, and Ohio).

Our employees work hard, play hard, and give back. Meridian employees enjoy: Happy hours, special events, company sports teams, potlucks, Bagel Fridays, weekly Executive Lunches, and volunteer opportunities.

RESPONSIBILITIES:

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Direct overall activities of claims examiners and maintain appropriate staffing levels. Ensure that the staff maintains adequate expertise in claims, eligibility, and policy interpretation, while meeting or exceeding production and accuracy standards.
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Develop performance expectations and standards for claims examiners, revise as situations dictate, and identify requirements for future training needs
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Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries
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Handle Third Party Liability investigations and complete necessary reporting to the State
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Ensure accurate Coordination of Benefits for Secondary Payer Payments for all lines of business
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Develop, Implement and maintain a High-Dollar claims process with business owners for all lines of business. Ensuring proper oversight and insight to the potential outlier claims from an UM, Care Coordination and contract perspective
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Review and advise on those claims with the highest complexity and sensitivity, and those that exceed claims examiners payment authorizations
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Prepare status reports that provide clear and concise information regarding claims status
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Complete claim payment cycle including posting claim payments, printing remittance vouchers and forwarding necessary information to the finance area for check processing
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Administer and adhere to company and department policies and procedures
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Champion the build of a new claims module for all lines of business to ensure high efficient and effective claims processes to meet current and future business demands
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Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output

WHAT YOU CAN BRING TO MERIDIAN:

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Bachelor's Degree or Fellow designation from the Academy for Healthcare Management (AHM) is required
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5 years of previous claims management experience is required
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Medicaid, Medicare, Health Exchange and Commercial experience preferred, but not required
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Previous experience in a leadership role is required