Health Insurance Operations Manager jobs in Middlesex, NJ

Health Insurance Operations Manager manages and maintains daily health insurance operations in multiple service areas, including account installation, implementation, client support, contract administration, claim processing, and enrollment and eligibility. Handles and settles complicated customer service issues which can not be resolved by lower level staff. Being a Health Insurance Operations Manager monitors performance of each service area. Requires a bachelor's degree or its equivalent. Additionally, Health Insurance Operations Manager typically reports to senior management or Director. The Health Insurance Operations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Health Insurance Operations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Operations Manager
  • Neighborhood Health
  • Plainfield, NJ FULL_TIME
  •  
               OPERATIONS MANAGER

    Reports To: Chief Operating Officer                                            Department: Administration

    Classification: Non-Exempt                                                  Grade:
    Date Approved:                                                                      Scheduled: FT 40 hrs per week

    POSITION SUMMARY:

    Responsible for managing all the daily operations that take place at NH. Planning operations from the beginning and implementing them after approval of the COO. Increase the efficiency of services. Implements budgetary controls within Operations. Assists the COO in making plans for future business ventures. Represent Operations Department at the staff meetings; gives a progress report to the COO for the board. Responsible for overseeing all construction projects; responsible for purchasing and bid process. Chairs Environment of Care & Emergency Management Committees, IT department and EMR. Provides leadership, guidance and direction, while ensuring that the organizational mission, values and expectations are met. Participates as a member of the Leadership Team and provides input into decisions affecting the objectives of NH in general. Directs and manages the staff and functions of the following departments: Maintenance, Security, Information Technology, Call Center, and Purchasing.

    ESSENTIAL FUNCTIONS and PRINCIPAL ACCOUNTABILITIES:
     
    • Operations Planning.
    • Data report management.
    • Prepares or assists in preparing annual and periodic budgets with the goal of providing essential services in the most cost-effective manner.
    • If appropriate, conducts periodic patient or client satisfaction surveys, reports results, and adjusts activities as indicated.
    •  WRAP and LOA Calculations - responsible for data collection and reports for the calculations associated with the supplemental payments associated with Federally Qualified Health Center's (FQHC's) Medicaid payments and Self- Patient payments, including submission to the State.
    • Supports physician peer review processes by ensuring the collection and analysis of data for provider scorecards, quality metrics, etc. 
    • Analyzes all assigned areas for opportunities of improvement and makes applicable recommendations for process, system, procedure, and operational changes to improve healthcare value and quality i.e.: Core Measures, Value-Based Arrangements, etc. 
    • Assists in the establishment of operational performance measurements and the monitoring of trends in key performance indicators to evaluate effectiveness, reliability, efficiency, etc. using available information systems data. Where other data is necessary but not readily available, will design and implement appropriate data collection. Uses data from appropriate external sources, including comparative databases. 
    • Assists senior management, providers, and leadership to ensure efficient and cost-effective operations in the standardization of best practices and processes.
    • Assures retention of required records.
    • Assures compliance with all quality and ethical standards, policies and procedures, as well as all applicable laws and regulations.

    CORE ABILITIES COMPETENCIES INCLUDE:
    • Customer Service: Provides and delivers professional, helpful quality service and assistance before, during, and after the customer’s needs are met.
    • Communication: Is professional, respectful and responsive when communicating with all parties whether it be spoken or written.
    • Teamwork: works cohesively with others, creating a positive working atmosphere, and supporting each other to combine individual strengths to enhance team performance.
    • Analytical/Problem Solving: Uses intuition, training, and work experience to solve problems by making decisions that are sensible given the available information.
    • Planning/Organizing: Establishes priorities systematically, differentiating between urgent, important, and unimportant tasks.
    • Ethical Skills: being in accordance with the rules or standards for right conduct or practice; upholds organizational values.
    • Adaptability: Open to new ideas, flexible enough to work through challenging issues, changes to work requirements or flows and generally able to cope when things don’t go as planned.
    • Confidentially: Understands customer’s rights to have personal, identifiable medical, or other information kept private.
    • Compliance: Adheres to guidelines as set forth by federal, state and local regulatory and accrediting bodies.
    • Quality: Provides quality service to customers to achieve desired outcomes consistent with current professional standards.
    • Safety and Security: Observes safety and security procedures; Uses equipment and materials properly.
    • Attendance/Punctuality: Reliable and dependable, reports for duty as scheduled and on time.

    Education or Formal Training:

    • Bachelor's degree in healthcare administration, information systems or a similar field of study with a strong analytical base required. 
    • A minimum of Four (4) years' experience in healthcare administration and information systems required. 
    • Knowledge of CMS/HRSA/NJDOH/ Joint Commission standards and regulations.
     

    Specific Skills or Knowledge:

      • Strong collaboration skills, written and verbal communications skills.
      • Attention to detail and analytical skills. Strong interpersonal, organizational and customer service skills.
      • Ability to plan, coordinate, and facilitate the implementation. Ability to work independently and as part of a team.
      • Initiative, good judgment and the ability to achieve results. Intermediate skills with Microsoft Excel.
      • Proficiency with MS PowerPoint.
      • Bi-Lingual in Spanish is a plus.


     

    Additional Responsibilities:

    This position may be required to perform other duties as assigned or when necessary. If such work becomes a permanent and regular part of the job, a new job description will be prepared.

    This job description should not be construed to imply that these requirements are the exclusive standards of the position. Incumbents will follow any other instructions and perform any related duties as may be required by the Board or CEO. As with all Neighborhood Health Services Corporation positions, this position's continuation is subject to sufficient funding resources. In addition, all NHSC employees may be required to work at any and all work sites of the organization.
  • 16 Days Ago

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Operations Manager
  • CVS Health Retail
  • Scotch Plains, NJ FULL_TIME
  • The Operations Manager is a member of the Store Management team, and as such, fulfills the company purpose of helping people on their path to better health by driving store execution and performance w...
  • 21 Days Ago

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Operations Manager
  • CVS Health Retail
  • New Providence, NJ FULL_TIME
  • The Operations Manager is a member of the Store Management team, and as such, fulfills the company purpose of helping people on their path to better health by driving store execution and performance w...
  • 1 Month Ago

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Commercial Insurance Agency Manager
  • Colonial Insurance Management Inc
  • Keyport, NJ FULL_TIME
  • Job DescriptionJoin Colonial Insurance Ageny, a leading insurance agency deeply rooted in Keyport, New Jersey. As a Commercial Insurance Agency Manager, you'll oversee our dynamic team, ensuring smoot...
  • 12 Days Ago

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Health Information Operations Supervisor
  • CIOX Health
  • Red Bank, NJ OTHER
  • Overview Who we are... Datavant protects, connects, and delivers the world’s health data to power better decisions and advance human health. We are a data logistics company for healthcare whose produc...
  • 10 Days Ago

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Innovation Program Manager
  • AXIS Insurance
  • Red Bank, NJ FULL_TIME
  • This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and s...
  • 2 Months Ago

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0 Health Insurance Operations Manager jobs found in Middlesex, NJ area

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Sr. Quality Compliance Analyst
  • AbbVie
  • Somerville, NJ
  • Company Description AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious he...
  • 4/24/2024 12:00:00 AM

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Claims Director, Personal Injury Protection
  • Plymouth Rock Assurance
  • Woodbridge, NJ
  • The Personal Injury Protection (PIP) Claims Director provides business leadership and strong technical skills for the Cl...
  • 4/23/2024 12:00:00 AM

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Account Manager - Personal Lines Insurance - High Net Worth Private Client
  • World Insurance Associates LLC
  • Iselin, NJ
  • *Candidates with experience with High Net Worth clients / Private Client encouraged to apply. Summary World Insurance As...
  • 4/23/2024 12:00:00 AM

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Underwriting Operations Technician
  • MSIG Holdings USA, Inc.
  • Warren, NJ
  • MSIG North America continues to grow! Responsible for supporting the underwriting process for multiple lines of insuranc...
  • 4/22/2024 12:00:00 AM

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Lower Middle Market Underwriter
  • Chubb
  • Plainfield, NJ
  • Job Description The Lower Middle Market New Business Production Underwriter position is a high-impact role that is 100% ...
  • 4/22/2024 12:00:00 AM

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AVP Executive General Adjuster
  • Chubb
  • Plainfield, NJ
  • Job Description Executive - General Adjuster This position will have three primary responsibilities: - Large and Complex...
  • 4/22/2024 12:00:00 AM

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Loss Prevention Supervisor
  • The TJX Companies, Inc.
  • South Brunswick, NJ
  • This position shift is Monday - Friday 10am - 6:30pm The Opportunity: Contribute To The Growth Of Your Career. Come to w...
  • 4/21/2024 12:00:00 AM

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Senior Claims Specialist
  • Everest Insurance
  • Warren, NJ
  • Title: Senior Claims Specialist Company: Everest Insurance Company Job Category: Claims Job Description: The ideal candi...
  • 4/20/2024 12:00:00 AM

Middlesex is a borough in Middlesex County, New Jersey, United States. As of the 2010 United States Census, the borough's population was 13,635 reflecting a decline of 82 (-0.6%) from the 13,717 counted in the 2000 Census, which had in turn increased by 662 (+5.1%) from the 13,055 counted in the 1990 Census. Middlesex was incorporated as a borough by an act of the New Jersey Legislature on April 9, 1913, from portions of Piscataway Township, based on the results of a referendum held on May 6, 1913.[21] The borough's name derives from Middlesex, England.[22][23] According to the United States C...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Health Insurance Operations Manager jobs
$122,509 to $166,547
Middlesex, New Jersey area prices
were up 1.5% from a year ago

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