at MetroPlus Health Plan

Job Detail




3+ years minimum experience

Schedule Type

Full Time


160 Water St, New York, NY 10038, USA




08/22/2019, 05:17 PM


Deputy Director of Claims System Operations # 38540 Job Description Direct the operations of Provider File Maintenance Coordination of claims system activities with the CORE Systems Director Direct the claims systems testing and audits to ensure continuous operations Advise on process restructuring activities and optimization of work groups around complex claim processing issues and edits. Maintain and track open issues and coordinate process solutions Identifies and resolves operational issues using well defined/documented processes, expertise and judgment. Participate on various forums, company initiatives, and other internal/external workgroups to provide oversight for issues related to claim system operations Collaborate with other MetroPlus business groups to develop, document and standardize procedures and workflows to support operational improvement. Act as a consultant for senior management on systems operation, recommend changes for system design, methods, procedures and workflows affecting claims operations Leverage existing technology by identifying opportunities to automate manual processes and identify opportunities to incorporate new technology into processes and flows. Performs other independent duties and projects as assigned. Minimum Qualifications Bachelor’s Degree or equivalent work experience required 3-5 years of management experience with demonstrated success in managing operations 2-3 years claim management experience Extensive knowledge of claims processing systems; DST systems preferred Experience in implementing claims systems and peripheral systems Testing interfacing upgrade modules Thorough knowledge and experience of procedures and guidelines in claim processing Strong client focus, that centers around advocacy and seamless client experiences Organization, time management, planning and project management skills, ability to manage multiple priorities to meet deadlines. Ability to think both tactically and strategically in addressing issues resolutions. Ability to create/analyze reports and utilize data to drive results. Ability to plan workflows effecting one or more departments, and exercise initiative and judgment as well as make decisions within the scope of assigned authority. Demonstrates leadership abilities with business units using appropriate influencing and consensus building skills to manage expectations and cultivate relationships. Ability to manage multiple projects and tasks. Excellent interpersonal, verbal and written communication skills. Proficiency in Microsoft Office Products Professional Competencies Integrity and Trust Customer Focus Functional/Technical skills Written/Oral Communication