Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
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Facility: Cherapa Place Building
Location: Sioux Falls, SD
Address: 300 N Cherapa Pl, Sioux Falls, SD 57103, USA
Job Schedule: Full time
Weekly Hours: 40.00
Ensures claims are accurately and timely administered by Sanford Health Plan, which contributes to a seamless experience for our members, providers and clients. Responsible for the performance, strategic leadership and oversight of all claims functions and processes. Develops and designs claim operations processes to ensure that service to our member/provider is priority. Actively leads efforts to improve systems, processes and contracts that result in top performance in claims administration.
Directs overall claim operations. Coordinates and manages the strategy for multiple locations as they share job functions. Responsible for the direction, coordination, planning, budgeting and oversight of all activities related to the claims department work. Ensures compliance with internal policies and regulatory requirements. Establishes policies and procedures. Identifies and resolves operational, organizational and business problems that affect claims.
Responsible for developing metrics and accountabilities for the department functions. Determines performance objectives/metrics and defines tools to measure progress and ensure consistent achievement of business objectives. Proactively monitors operational performance; initiates and drives appropriate change in processes, tools and capabilities that increase operational efficiency and effectiveness. Meets Sanford Health Plan metrics for auto-adjudication rates, EDI rates, clean claims timeliness, claim adjustment rates and claims financial accuracy.
Understands and aligns with the strategic vision and executional priorities. Collaborates with the leadership team. Provides leadership and direction for claims administration. Builds and fosters relationships within the organization to proactively resolve claim errors/issues and drive efficiencies. Leads and develops a team. Demonstrates the ability to provide strong leadership that mentors, develops and guides.
Manages the resolution of diverse complex issues where analysis requires an in-depth knowledge of multiple functions and Sanford's objectives. Assesses multi-faceted issues and proposes alternatives. Strong analytical skills with ability to drive change and manage programs essential. Strong verbal, written and interpersonal skills required. Must be able to prioritize and delegate tasks effectively. Must be able to handle stressful situations. Others duties as assigned.
Bachelor's degree required.
Five years in claims management required.
Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to email@example.com .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.
Job Function: Health Plan
Req Number: R-33343