More jobs:
Claims Operations Director
Job in
Tallahassee, Leon County, Florida, 32318, USA
Listed on 2025-12-02
Listing for:
Capital Health Plan
Full Time
position Listed on 2025-12-02
Job specializations:
-
Healthcare
Healthcare Management, Healthcare Administration -
Management
Healthcare Management
Job Description & How to Apply Below
Job Summary
Directs the activities of claims administration staff in providing the timely and accurate processing of claims, encounters, and OPL recoveries. Directs the activities related to billing and reconciliation of premium payment by employers and individuals. Directs the activities of contract administration function in appropriate and timely software updates, code/fee configurations, and overall provider and contract administration. Directs the activities of payment integrity staff in root cause analysis of claims related issues, third party vendor oversight, and claims related risk adjustment processes.
Supports the implementation of software enhancements.
- Bachelor's degree (BA/BS) from a four‑year college or university; or one to two years' related experience and/or training; or equivalent combination of education and experience.
- Ten years related experience preferred.
- Seniority level:
Director - Employment type:
Full‑time - Job function:
Management and Manufacturing - Industries:
Hospitals and Health Care
Location:
Tallahassee, FL | Salary: $65,000 – $100,000
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