Manager of Claim Data Management - Pailin Group PSC : Job Details

Manager of Claim Data Management

Pailin Group PSC

Job Location : all cities,CA, USA

Posted on : 2025-08-11T00:45:46Z

Job Description :

Req No 2019-9278 Category Managed Care Type Regular Full-Time

Job Overview

The Manager of Claim/Provider Data Management is an integral part of the organization's Managed Care Division's leadership team. He or she is responsible for projecting and integrating the Mission and Core Values of the organization in the provision of provider data management services to internal and external customers of the Managed Care Division.

Key Responsibilities
  • Oversee the day-to-day operations of the Provider Data Management Department.
  • Direct the configuration of the organization's provider management system for accurate and compliant adjudication of claims from the organization, Medicare and Medicaid health plans, Ryan White Care Act (RWCA) programs, and wellness and prevention programs.
  • Manage the claims suspense/errors file.
  • Lead the PDM staff by connecting daily activities to the mission and core values of the organization.
  • Develop and implement the organization's contracts and fee schedules that meet national claims adjudication standards.
  • Ensure compliance with standards required by the Centers for Medicare and Medicaid Services (CMS), California Department of Health Care Services, Florida Agency for Health Care Administration, and state-issued standards.
  • Oversee claims pre-processing vendors.
    • Management Philosophy

    The Manager of Claim/Provider Data Management is responsible for implementing and adhering to a management philosophy of mission-driven fairness, learning, hands-on accountability, and tenacity in the leadership of the Claims Department. He or she contributes to the organization's success.

    TO APPLY

    Forward resumes and salary requirements to Debra Hartmann at [email protected].

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