Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
We are searching for a Manager, Medical Claims Administration - someone who works well in a fast-paced managed care setting. In this position, you’ll plan, develop and implement Claims processing functions and related processes for the Claims Administration Department. You’ll have key responsibility for the integrity of the claims payment and adjudication process. Additionally, you’ll be responsible for ensuring that claims are processed accurately and timely for reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage.
Think you’ve got what it takes?
Skills & Requirements
Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption.
Required H.S. Diploma or equivalent
Bachelor's degree HIGHLY PREFERRED
Bachelor's degree with substitute for four (4) of the required years of experience
Required 7 years Health Plan claims administration or related experience
2 years of leadership experience (Preferred)
Job Duties & Responsibilities
Plan, develop, organize and implement processes to ensure timely and accurate claims processing
Plan, develop, organize and implement processes to ensure claim adjustments, appeals and correspondence is completed timely and accurately
Develop policies and procedures and for a Pediatric HMO which are based on our integrated delivery system goals and objectives and which meet the performance goals and measurements
Mentor and develop Claims Processing staff toward expansion of job roles in order to meet the continuous challenges and changes of the health care environment, contracts and governmental regulations, including promoting the ability to respond effectively to innovative initiatives
Plan, develop organize and implement claim processing functions and processes
Completes timely performance appraisals for direct reports
Conducts appropriate investigations and follows-up on Provider and Member complaints
Strives to achieve the goal of accreditation with commendation
Review and implement Texas Department of Insurance regulations pertaining to HMOs
Review and implement HHSC statutory reporting requirements of Texas Medicaid
Thank you for your interest in applying for this job position.
Texas Children’s is excited to announce that we are transitioning to a new applicant tracking system. During this transition, from April 11-17, 2016 our application functions on our Careers website will be temporarily deactivated.
We sincerely apologize for this inconvenience. Visit us on Monday, April 18, 2016 to check out our new features and apply!