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Experience:
No experience
Employment Type:
Intern/Co-op
Posted:
6/12/2015
Job Category:
Health Care Provider
Industry:
Health Care & Medicine
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Claims Processing Director
Kaiser Permanente | Aurora, Colorado
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Job Description

The incumbent serves as the Regions Outside of California (ROC) designated primary point of contact for Claims Quality.

Has responsibility for providing leadership, supervision and direction for operational, financial, and compliance audits that gauge performance for Claims Administration.

Has responsibility for the direction, coordination, planning, budgeting, and oversight of all activities related to the department work.

Has responsibility for designing quality assurance programs and practices to ensure compliance with internal policies and regulatory requirements.

Has responsibility for developing metrics and accountabilities for the department functions.

Has responsibility for coordinating and managing the cutover strategy for regions as they transition into shared service.

Establishes effective relationships with key customers to include national and regional executives, directors, managers and functional leaders.

Actively participates in efforts to improve systems, processes & contracts that result in top quartile performance in claims administration.

 

 

 

This position, reporting to the Executive Director, California Claims Administration, will have primary responsibility for:

 

Leads management team to establish strategic plans and objectives for the function; may assist with developing some cross-functional oriented objectives.

 

Has overall control of planning, staffing, budgeting, managing expense priorities, performance requirements, and recommending and implementing changes to methods.

 

Influences the development and execution of functional and KP-wide policies and long-term goals.

Participates in development of methods, techniques and evaluation criteria for projects, programs, and people.

 

Actions and decisions affect virtually all areas of KP.

 

Responsibilities impact the integrated achievement of functional and KP objectives, that strongly contribute to long-term success or failure.

 

Erroneous decisions/recommendations would result in failure to achieve the major goals and objectives of KP as well as have a long-term effect on KPs success.

 

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanentes policies and procedures.

 

Manages the resolution of diverse and complex issues where analysis of situations or data requires an in-depth knowledge of multiple functions and KP objectives.

 

Assesses multi-faceted sophisticated issues and proposes unprecedented alternatives.

 

Involves the highest degree of interpretation and management of obscure or inconclusive data.

 

Makes final decisions on all administrative and operational matters and ensures effective achievement of objectives.

 

Requires a broad range of highly complex decision-making.

 

Decisions are commonly precedent setting.

 

Uses understanding of the vision for KP to ensure that all actions taken within the regions are aligned.

 

Exercises considerable latitude in determining functional objectives and direction.

 

Review of operational results and impact would be at the executive level.

 

 

 

The incumbent serves as the Regions Outside of California (ROC) designated primary point of contact for Claims Quality.

Has responsibility for providing leadership, supervision and direction for operational, financial, and compliance audits that gauge performance for Claims Administration.

Has responsibility for the direction, coordination, planning, budgeting, and oversight of all activities related to the department work.

Has responsibility for designing quality assurance programs and practices to ensure compliance with internal policies and regulatory requirements.

Has responsibility for developing metrics and accountabilities for the department functions.

Has responsibility for coordinating and managing the cutover strategy for regions as they transition into shared service.

Establishes effective relationships with key customers to include national and regional executives, directors, managers and functional leaders.

Actively participates in efforts to improve systems, processes & contracts that result in top quartile performance in claims administration.

 

 

 

This position, reporting to the Executive Director, California Claims Administration, will have primary responsibility for:

 

Leads management team to establish strategic plans and objectives for the function; may assist with developing some cross-functional oriented objectives.

 

Has overall control of planning, staffing, budgeting, managing expense priorities, performance requirements, and recommending and implementing changes to methods.

 

Influences the development and execution of functional and KP-wide policies and long-term goals.

Participates in development of methods, techniques and evaluation criteria for projects, programs, and people.

 

Actions and decisions affect virtually all areas of KP.

 

Responsibilities impact the integrated achievement of functional and KP objectives, that strongly contribute to long-term success or failure.

 

Erroneous decisions/recommendations would result in failure to achieve the major goals and objectives of KP as well as have a long-term effect on KPs success.

 

Consistently supports compliance and the Principles of Responsibility (Kaiser Permanentes Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licensure requirements (if applicable), and Kaiser Permanentes policies and procedures.

 

Manages the resolution of diverse and complex issues where analysis of situations or data requires an in-depth knowledge of multiple functions and KP objectives.

 

Assesses multi-faceted sophisticated issues and proposes unprecedented alternatives.

 

Involves the highest degree of interpretation and management of obscure or inconclusive data.

 

Makes final decisions on all administrative and operational matters and ensures effective achievement of objectives.

 

Requires a broad range of highly complex decision-making.

 

Decisions are commonly precedent setting.

 

Uses understanding of the vision for KP to ensure that all actions taken within the regions are aligned.

 

Exercises considerable latitude in determining functional objectives and direction.

 

Review of operational results and impact would be at the executive level.

 

 

 

Qualifications

Basic Qualifications:
Experience
Minimum ten (10) years of experience in a claims processing environment with seven (7) years of management experience.
Education
Bachelor's degree in business administration OR four (4) year of experience in a directly related field.
High school diploma or General Education Development (GED) required.
License, Certification, Registration
N/A.


Additional Requirements:
Experience in managing large groups of employees in a collaborative work team environment required.
Requires expert knowledge of claims processing and advanced knowledge of multiple related functions.
Must be able to work in a Labor/Management Partnership environment.

 


Preferred Qualifications:
Master's degree preferred.

 

Basic Qualifications:
Experience
Minimum ten (10) years of experience in a claims processing environment with seven (7) years of management experience.
Education
Bachelor's degree in business administration OR four (4) year of experience in a directly related field.
High school diploma or General Education Development (GED) required.
License, Certification, Registration
N/A.


Additional Requirements:
Experience in managing large groups of employees in a collaborative work team environment required.
Requires expert knowledge of claims processing and advanced knowledge of multiple related functions.
Must be able to work in a Labor/Management Partnership environment.

 


Preferred Qualifications:
Master's degree preferred.

 

About Kaiser Permanente

Company Description

Serving approximately 8.7 million members in nine states and the District of Columbia, Kaiser Permanente is America's leading nonprofit integrated health plan.

Kaiser Permanente's mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve.

Our Northern California Region provides integrated health care services to approximately 3.2 million members. Approximately 4,400 physicians of The Permanente Medical Group provide services at 20 medical centers and numerous medical offices.

Company History

Founded in 1945, Kaiser Permanente is the nation’s largest not-for-profit health plan, serving more than 8.6 million members, with headquarters in Oakland, Calif. It comprises:

  1.   • Kaiser Foundation Health Plan, Inc.

  • Kaiser Foundation Hospitals and their subsidiaries

  • The Permanente Medical Groups.

At Kaiser Permanente, physicians are responsible for medical decisions. The Permanente Medical Groups, which provide care for Kaiser Permanente members, continuously develop and refine medical practices to help ensure that care is delivered in the most efficient and effective manner possible.

Kaiser Permanente’s creation resulted from the challenge of providing Americans medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Among the innovations it has brought to U.S. health care are:

  • prepaid health plans, which spread the cost to make it more affordable

  • physician group practice to maximize their abilities to care for patients

  • a focus on preventing illness as much as on caring for the sick

  • an organized delivery system, putting as many services as possible under one roof

Mission & Values

As a health care organization in the 21st century, we have a mission--to provide quality care for our members and their families, and to contribute to the well-being of our communities.

Working Here

When you bring your career to Kaiser Permanente, the work you do directly affects the health of millions. From the business people who shape our policies, to the IT professionals enabling life-saving data, to the nurses and physicians on the front line of patient care, everyone here has a role to play in the care continuum. Knowing you have a place in that process and witnessing the outcome of the work you do is empowering. It gives you a cause to stand behind. And it makes you feel proud of the work you do every day. When people witness the impact of their contributions, they excel. Together we have the power to make a difference.

Hiring Information

The first step in beginning your career search is to look for open jobs that match your skills, qualifications, and interests. Each posting includes a description of the position and the minimum required qualifications. Once you find a position you are interested in, register for an account and provide your information for consideration online.

Benefits

As an employee, you are eligible for benefits according to your full-time/part-time status and the number of hours scheduled to work per week. Benefits may vary based on your Kaiser Permanente region, position, scheduled hours, and representation by collective bargaining or employee groups, but generally include:

  • generous vacation, holiday, and sick leave

  • medical care (including prescriptions), vision, mental health, and dental care

  • disability and life insurance coverage

  • educational opportunities and tuition reimbursement

  • employee assistance programs

  • health care, dependent care, and transit spending account options

  • retirement plans

In addition, we believe in recognizing stellar performance and sponsor a variety of programs designed to reward our skilled, innovative, caring, and committed staff.

In short, at Kaiser Permanente, we understand that there is a direct correlation between happy employees and happy members. We take pride in the compassion and dedication of our employees and find many ways to reward their hard work. In return, our employees take pride in being a part of a collaborative, professional team focused on quality, service, and care.

Honors & Awards

Kaiser Permanente of Northern California has earned an "Excellent" rating from the National Committee for Quality Assurance (NCQA)-the nation's leading reviewer of health plan quality for consumers and employers. Excellent is the top rating granted by NCQA, which reviews satisfaction surveys, preventive measures, physician credentialing, member services and improvement initiatives.*

Both our Northern and Southern California regions were the only health plans in California identified by the NCQA in its list of the best health care programs in the Pacific States. (NCQA's The State of Health Care Quality 2003)

The Joint Commission on Accreditation of Healthcare Organizations accredits all Kaiser Foundation Hospitals in California.

For the seventh straight year, no other health plan has earned higher ratings from the California Cooperative Health Reporting Initiative on more measures than Kaiser Permanente. The annual ratings measure clinical quality and member satisfaction. (CCHRI Report on Quality 2003)

Our Northern California region received more three-star "Excellent" ratings than any other health plan surveyed by California's Office of the Patient Advocate on California's Quality of Care Report Card 2003-04.

* Commercial HMO and Medicare-contracted product lines: April 2003.