Manager, MIG Claims - Michigan - McLaren Health Care : Job Details

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We are looking for a MIG Manager Claims, to join us in leading our organization forward.McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive.As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at .MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at .Position Summary:Provides overall management in providing superior claims operations for McLaren Integrated HMO Group's health plan subsidiaries (HP). Specific areas of responsibility include, but not limited to, claims administration, administering and maintaining the claims module, payment integrity and recovery operations, and identifying and addressing provider payment discrepancies. Develops and implements policies and procedures to promote the operational integrity for HP. Coordinates interdepartmental reports and statistics for senior management, state regulators, compliance, and accrediting agencies. Responsible to analyze, develop and implement training programs and procedures for operational staff. Designs, implements and adjusts workflows to ensure departmental efficiencies are maintained. Responsible for monitoring staff performance relative to departmental standards and designing corrective action plans as necessary.This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.Equal Opportunity Employer of Minorities/Females/Disabled/VeteransQualifications:Required:

• Bachelor's Degree in health care, business, or related field.
• Five (5) years progressive experience in a leadership role leading including three (3) years' experience in a supervisor role leading a professional staff of five or more members in all phases of effective supervision (ie. Recruitment, performance management, training).
• Four (4) years' experience in health plan claims, billing or claims adjudication operations for multiple subsidiaries or business units.

Preferred:

• Certification as appropriate to position.
• Demonstrated experience in developing adjudication logic to support automated claims processing.
• Five (5) years' experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, claims processing, membership/eligibility)
• Affiliation with a Professional Organization.

Additional Information

• Schedule: Full-time
• Requisition ID: 25004448
• Daily Work Times: 8:00 am - 5:00 pm
• Hours Per Pay Period: 80
• On Call: No
• Weekends: No

Seniority level

• Seniority levelMid-Senior level

Employment type

• Employment typeFull-time

Job function

• Job functionFinance and Sales
• IndustriesHospitals and Health Care

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