Assistant Director, Claims Administration - The Health Plan

 
Position: Assistant Director, Claims Administration - The Health Plan

Job ID: 150133

Location: US-TX-Bellaire

Department: Administration-TC Health Plan

Talent Area: Professional - Non-Clinical

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p Monday - Friday

About Texas Children's Hospital

The Texas Children’s Hospital system is the largest pediatric integrated care system and is an industry leader in pediatric population health.    Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children and pregnant women.  We are an Integrated Community System providing holistic care that empowers families to live healthier lives.  Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.  Currently, the Health Plan serves more than 450,000 members across three state territories (Harris, Jefferson, North East), who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. To join our community of 13,000 dedicated team members, visit www.texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at www.infinitepassion.org

Summary:

We are searching for an Assistant Director of Claims Administration — someone who works well in a fast-paced managed care setting. In this position, you will oversee, develop, implement, and maintain the claims administration functions of the organization. You will be responsible for the integrity of the claims payment and adjudication process while ensuring that claims are processed accurately and timely for reimbursement to the health plan providers and members.

 

Think you’ve got what it takes?



Responsibilities :

Job Duties & Responsibilities

HOU123

  • Organize, direct, and implement a coordinated approach to administering health care benefits for children under the guidelines of a primary and secondary Pediatric HMO
  • Ensure the delivery of cost-effective, community-based, and culturally sensitive health care through documenting/reporting and education, with continuous quality improvement as a focus
  • Develop policies and programs for Medicaid and CHIP HMO based on the organization’s integrated delivery system goals and objectives, and meet performance goals and measurements
  • Mentor and develop staff towards the expansion of their job roles in order to meet continuous challenges and changes in the health care environment
  • Implement and maintain the claims administration functions and processes in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage


Qualifications:

Skills & Requirements

 

  • Bachelor’s degree in a business-related field
  • Minimum 4 years of claims management and/or oversight experience
  • Minimum 4 years of direct supervisory experience

 



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