Claims Systems Manager; Remote

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Full Time Albemarle, NC, US 1 Attachments

Competitive Compensation & Benefits Package!

Position eligible for –

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 13 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Office

Location:

Remote option;
Must live in one of the following states:
Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, or Virginia

Projected Hiring Range: $99,963.31 - $ (DOE)

Closing Date: Open until filled

The Claims System Manager will provide strategic leadership and oversight to a team of Systems Analysts responsible for managing and monitoring Vaya Partners claims management system and supporting applications. Operating within the Information Services division and collaborating with cross-functional teams, the Claims System Manager will play a pivotal role in defining and implementing the strategic roadmap for Vaya Partners Claims Management software application, ensuring alignment with the organization's overall strategic plan and mission, vision, and values.

Key responsibilities include overseeing and managing staff and vendors responsible for system configuration, development, implementation, maintenance, and technical support. This role requires extensive interaction with internal and external stakeholders to address all aspects of claims processing and resolve any issues or concerns.

Additional responsibilities encompass the oversight of Business Requirement Documents (BRDs), vendor contracts, and service desk ticket resolution, all while adhering to organizational policies and contractual requirements. This position also involves escalating items that are behind schedule or pose a risk to the organization if not complete. The successful candidate will be detail-oriented, capable of providing regular status updates to stakeholders, and ensuring timely resolution of all assignments and issues.

The Claims System Manager will work closely with cross-functional teams to address escalations promptly and effectively, striving for streamlined, efficient solutions that align with organizational objectives. This position will ensure that software technologies related to Vaya Partners claims management system and associated applications are used in accordance with current policies and procedures and will be familiar with North Carolina Medicaid rules and regulations.

• Directs and provides oversight to the Claims Systems Analyst Supervisor(s) team including but not limited to:
  • Ensuring supervision and administrative functions are addressed per policy and in a timely manner such as the hiring, supervising, evaluating, and mentoring the Claims System Analyst team.
• Monitors current workload and business requirements for the purpose of maintaining adequate staffing, enhancing productivity of personnel.
• Facilitate the design, development, implementation, and operation ofthe claims management and associated software systems.
• Provides daily status updates to upper management as directed by the VP of Business Services
• Monitors, tracks, and escalates the status of Business Requirements Documents (BRDs), vendor contracts, and ticket resolution. This includes maintaining detailed records and providing regular status updates to appropriate stakeholders.

• Provides oversight and participates in the selection, implementation, and maintenance of software applications.
• Working within Vaya Partners Project Management policy and guidelines, allocates resources for projects and support requests, ensuring priorities are aligned with divisional and organizational priorities while meeting stated deadlines.
• Complete required project reports and documentation to ensure organizational leadership and project stakeholders are aware of a project’s health and status on a regular basis
• In conjunction with the PMO team, ISD leadership and others, develop and communicateorganizationalvision and direction to Claims System team and stakeholders throughout projects.
• Working with the Cloud and…