Job Description
An employer is looking for a highly-skilled remote claims focused Capability Manager to join one of our largest national healthcare clients for a remote 12-month contract opportunity. In this role you'll join a growing team of 6 and be the liaison between scrum and claims team to ensure business processes are being pushed forward. In order to be successful on this team you must have prior experience working within claims and have prior experience working with CSP Facets.
Responsibilities:
o Mitigate any known or identified claim issues in production
o Resolve escalations
o Capture claims processing requirements per contractual and business partner needs along with the risk associated with non-compliance
o Evaluate the solutions presented for the best option at the lowest cost which supports the needs of the requirements minimizing manual solution use
o Communicate any scenarios to be tested and provide feedback on any observed gaps in the test execution
o Draft and deliver Polices and Procedures pertaining to Claim Processing for State partner requests
o Demonstrate system capabilities to State partners
o Socialize complex claim process changes with claim operations
o Train claim operations on any new State specific processes
o Execute an audit plan using SQL focused reports to validate production claim outcomes
o Drive resolution for issues impacting claim processing
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.
Required Skills & Experience
•Expertise in Medicaid and DSNP Claims Domain (Subject Matter Expert).
•Experience in capturing requirements in a healthcare setting.
•Knowledge of CSP Facets
•Claim Processing Experience
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.