Regional Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Regional Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Regional Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Regional Claims Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Regional Claims Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
Full Time Manager of Claims Health Plans for a Hybrid position, will be onsite in Corvallis 2-3 times a week or more if needed. We need a candidate with strong management experience.
Shift: Days.
W2 Benefits.
Minimum Years of Experience: 3
JOB SUMMARY/PURPOSE
Oversees and manages the Health Plans Claims Department. Is responsible for accurate and timely claims processing for all programs administered by Health Plans. Provides oversight to staff and ensures that the organization's performance expectations, financial standards, and goals are achieved. Enhances department bench strength by hiring, coaching and mentoring direct reports. Responsible for the completion and success of all internal and external claims audits. Analyzes claims data and ensures compliance requirements are met.
DEPARTMENT DESCRIPTION
operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Health Plans, Inc. offers Medicare Advantage, Commercial Large Group, and Commercial Large Group PPO and EPO plans; also the third-party administrator for Health Services’ self-funded employee health benefit plan. As part of an Integrated Delivery System, Health Plans is strategically and operationally aligned with Health Services’ mission of Building Healthier Communities Together.
EXPERIENCE/EDUCATION/QUALIFICATIONS
KNOWLEDGE/SKILLS/ABILITIES
Job Type: Full-time
Pay: $73,000.00 - $88,000.00 per year
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Work Location: Hybrid remote in Corvallis, OR 97330
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