Director, Claims Administration

About Texas Children's Hospital

Summary:

We are searching for a Director of Claims Administration — someone who works well in a fast-paced setting. In this position, you’ll oversee, plan, develop, implement, and maintain the claims administration functions and related processes of the organization. This role will be responsible for the integrity of the claim’s payment and adjudication processes. 

Think you’ve got what it takes?

Job Duties & Responsibilities

•    Oversees the coordinated approach to administering health care benefits for children under the guidelines of a primary and secondary Pediatric HMO 
•    Guarantees department adheres to all contractual obligations and statutory regulations
•    Ensures the delivery of cost-effective, community-based, and culturally sensitive health care through comprehensive contracting, medical management, and documenting/reporting
•    Develops approaches, policies, and programs for a Medicaid and CHIP HMO based integrated delivery system goals and objectives, and meets performance goals and measurements
•    Mentors and develops staff towards expanding job roles to meet the continuous challenges and changes in the health care environment
•    Supervises contracts and governmental regulations, including promoting the ability to respond effectively to innovative initiatives
•    Ensures that claims are processed accurately and timely for reimbursement to Health Plan Providers and members, and follows contracted fee schedules and covered benefits as specified in the member evidence of coverage

Skills & Requirements

•    Bachelor’s degree
•    5 years of managerial experience and 5 years of claims management and oversight experience
•    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.