Claims Operations Manager
Cambia Health Solutions

Portland, Oregon

This job has expired.


Claims Operations Manager

Telecommute Option - Must reside in ID, OR, UT or WA

WHO WE NEED

This position provides technical guidance, assistance and coordination of all ASO Operational activities. Ensures cost effective accomplishment of their division, the overall ASO Unit, and Cambia corporate goals and the effective operation of daily activities. The ASO Operations Manager may have responsibility for ASO Appeals, Complaints, Correspondence, Customer Service, Claims, Membership and Billing.

Normally to be proficient in the competencies listed above

The Manager of ASO operations would have:

  • Undergraduate degree with a major in business or healthcare
  • At least 5 years of progressive management and supervising experience related to health plan and benefit administration
  • Experience in managing people, projects and processes within a service environment.

FTEs Supervised

Up to 50

Preferred Key Experience:

Leadership Skills/Experience

Continuous Process Improvement

Collaboration Mindset

Fostering a Culture of Belonging

Multi-Level Communication Skills

Performance & Delivery Reporting

YOUR ROLE:
  • Strong understanding of the applicable laws and rules for the division.
  • Contract expert, knowledge and ability to execute all ASO contract obligations pertaining to their division.
  • Works with other ASO divisions to ensure ASO contract obligations are met.
  • Identifies and coordinates delivery of learning interventions directly linked to specific business initiatives and requirements.
  • Recommends, develops, promotes and coordinates training, continuing education and development efforts including departmental training to support short- and long-range corporate goals and objectives.
  • Forecast, budget and determine staff needs for the division.
  • Ensure all performance guarantees and MTM metrics related to the division are met.
  • Ensure all contract obligations are met.
  • Documents the work of the division and ensures processes are in place for all of the divisions work.
  • Ensure the implementation of new groups.
  • Participate in responding to RFP requests.
  • Manages Performance and Training Teams that support the Divisions work.
  • Maintains good working relationship and cooperate with all departments in the company.
  • Participate in company wide improvement and efficiency teams where appropriate. Leads, plans, develop and directs division activities.
  • Manages all activities related to the various electronic systems used to support the division.
  • Responsible for the activities performed by division staff to assure performance goals are met including productivity, accuracy, timeliness and quality of service to our groups, members and business partners.
  • Manages the development and maintenance of identified documentation which exists to support accurate, efficient operations.
  • Provides on-going leadership to employees by facilitating and making timely decisions, providing effective communication and motivation.
  • Ensures that performance is maintained within the approved budget and continually strives to support division or line of business profitability.
  • Actively participates in corporate planning teams, when division will be impacted.
  • Manages the day-to-day activities of the direct staff to achieve goals within budgeted funds and available resources. Plans and organizes workloads and staff assignments, reviews progress, and directs changes in priorities and schedules as needed to assure corporate goals are met.
  • Selects, manages, and evaluates staff. Prepares and conducts performance evaluations and initiates disciplinary actions as warranted. Provides training and motivation to make full use of individual capabilities.
  • Assesses divisions development needs and recommends strategies and tactics to meet goals. Serves as a member to management and supervisory committees as needed. Forecasts future training and development needs to ensure necessary employee skills for effective performance.

WHAT YOU BRING
  • Solid understanding and knowledge of all systems and processes used within the division, including system and staff capabilities.
  • Ability to communicate about the division's purpose, priorities and work to both internal and external stakeholders.
  • Demonstrated ability to plan and organize with emphasis on systems and management controls.
  • Good understanding of member service functions, including experience in managing high volume production environments.
  • Demonstrated project management skills.
  • Demonstrated ability in financial and budget management.
  • Ability to make decisions, accept responsibility and be held accountable.
  • Ability to communicate effectively, verbally and in writing, to all levels of the work force, clients and agents with exceptional results.
  • Demonstrated success in cost reduction and controls

The base pay annual salary range is: $84.2 - $145.1

The bonus target for this position is 15%

Regence employees are part of the larger Cambia family of companies, which seeks to drive innovative health solutions. We offer a competitive salary and a generous benefits package. Regence is 2.2 million members, here for our families, co-workers and neighbors, helping each other be and stay healthy and provide support in time of need. We've been here for members for 100 years. Regence is a nonprofit health care company offering individual and group medical, dental, vision and life insurance, Medicare and other government programs as well as pharmacy benefit management. We are the largest health insurer in the Northwest/Intermountain Region, serving members as Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield (in Washington). Each plan is an independent licensee of the Blue Cross and Blue Shield Association.

If you're seeking a career focused on making the health care experience simpler, better, and more affordable for people and their families, consider joining our team at Cambia Health Solutions. Cambia is a total health solutions company that is deeply rooted in a 100-year legacy of transforming the industry and the way people experience health care. We had our beginnings in the logging communities of the Pacific Northwest as innovators in helping workers afford health care. That pioneering spirit has kept us at the forefront as we build new avenues to improve access to and quality of health care for the future. Cambia is committed to delivering a seamless, personalized health care experience for the next 100 years.

At Cambia, we take a variety of factors into account when creating a job offer, including your skills, experience, education, and training; relevant licensure / certifications; performance history; and work location. While we offer competitive salaries, in general, we rarely hire candidates at or near the top of the salary range.

Base pay is just part of the compensation package at Cambia that is supplemented with an exceptional 401(k) match, bonus opportunity and other benefits. In keeping with our Cause and vision, we offer comprehensive well-being programs and benefits, which we periodically update to stay current. Some highlights:

  • medical, dental, and vision coverage for employees and their eligible family members
  • annual employer contribution to a health savings account ($1,200 or $2,500 depending on medical coverage, prorated based on hire date)
  • paid time off and company holidays
  • up to a 6% company match on employee 401k contributions, with a potential discretionary contribution based on company performance (no vesting period)
  • up to 12 weeks of paid parental time off (eligible day one of employment if within first 12 months following birth or adoption)
  • one-time furniture and equipment allowance for employees working from home
  • up to $225 in Amazon gift cards for participating in various well-being activities for a complete list see our External Total Rewards page.

We are an Equal Opportunity and Affirmative Action employer dedicated to workforce diversity and a drug and tobacco-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, national origin, religion, age, sex, sexual orientation, gender identity, disability, protected veteran status or any other status protected by law. A background check is required.

If you need accommodation for any part of the application process because of a medical condition or disability, please email CambiaCareers@cambiahealth.com. Information about how Cambia Health Solutions collects, uses, and discloses information is available in our Privacy Policy. As a health care company, we are committed to the health of our communities and employees during the COVID-19 pandemic. Please review the policy on our Careers site.


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