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Manager - Claims Integrity and Compensation
2 months ago
The primary objective of this position is to oversee the ancillary integrity and compensation operations aimed at identifying, preventing, and recovering financial losses due to claims leakage. This will be achieved through initiatives outlined in the Claims Integrity roadmap, utilizing process improvements, systems, and advanced analytics for enhanced operational effectiveness.
Key Responsibilities- Leadership: Direct the ancillary integrity and compensation teams to ensure efficient operations that align with financial targets.
- Stakeholder Engagement: Cultivate strong relationships with providers, legal professionals, and other payers to enhance claims detection and recovery.
- Performance Tracking: Implement measures to monitor financial performance against operational plans, reporting significant variances and opportunities for improvement.
- Data Science Collaboration: Provide expert input into the data science initiatives, serving as the main liaison with the Claims Integrity Data Science Team to optimize data utilization and process enhancements for improved claims detection and recovery.
- Quality Assurance: Establish robust quality assurance processes to ensure confidence in team outputs, confirming that team members are equipped with the necessary skills and that financial reporting is accurate.
- Professional Engagement: Maintain high standards of professionalism when interacting with external parties, ensuring exceptional customer service that upholds the company's reputation.
Working with us means you will enjoy a supportive environment that values your career and lifestyle. We offer a balanced work-life culture, leadership support, reduced health coverage costs, study leave, and a strong commitment to internal promotions. Your health and wellbeing are our top priorities, reflected in our daily practices.
Qualifications- Proven experience in leading a mid-sized team within the private health insurance, general insurance, legal, or service-based sectors.
- Strong ability to engage with both internal and external stakeholders to influence decisions and foster referrals.
- Capability to navigate the balance between commercial objectives and delivering an exceptional customer experience.
- Experience in collaborating effectively with a diverse range of stakeholders, including senior management and operational teams.
- Demonstrated success in partnering across functions to develop and implement strategies that achieve commercial results in complex organizations.
- Excellent written and presentation skills, with the ability to analyze complex data and communicate key insights to senior management.
Dental Corporation is dedicated to improving the health and wellbeing of individuals, committed to a mission of enhancing lives through comprehensive dental care services.
