Career | Texas Children’s People

Position: Assistant Director, Claims Administration - The Health Plan

Talent Area: Professional - Non-Clinical

Full/Part Time: Full time

Location: Houston, TX, US

Regular/Temporary: Regular

Department: Claims - Administration

Shift: 8a - 5p Monday - Friday

Job ID: 404543

We are searching for an Assistant Director of Claims Administration — someone who works well in a fast-paced setting. In this position, you will oversee, develop, implement, and maintain the claims administration functions of the organization. You will be responsible for the integrity of the claims payment and adjudication process while ensuring that claims are processed accurately and timely for reimbursement to the health plan providers and members.

Think you’ve got what it takes?

Job Duties & Responsibilities

•   Organize, direct, and implement a coordinated approach to administering health care benefits for children under the guidelines of a primary and secondary Pediatric HMO
•   Ensure the delivery of cost-effective, community-based, and culturally sensitive health care through documenting/reporting and education, with continuous quality improvement as a focus
•   Develop policies and programs for Medicaid and CHIP HMO based on the organization’s integrated delivery system goals and objectives, and meet performance goals and measurements
•   Mentor and develop staff towards the expansion of their job roles in order to meet continuous challenges and changes in the health care environment
•   Implement and maintain the claims administration functions and processes in accordance with contracted fee schedules and covered benefits as specified in the member evidence of coverage

Skills & Requirements

•   Bachelor’s degree in a business-related field
•   Minimum 4 years of claims management and/or oversight experience
•   Minimum 4 years of direct supervisory 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.

About Texas Children’s

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.

To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.

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.