Claims Recovery Manager

Transformation is the opportunity

Blue Shield of California is the third largest health plan in California, with about $7.5 billion in revenue. Our mission is to ensure Californian's access to high-quality health care at a reasonable price.

Join Blue Shield of California and grow your career with a leader that's stirring up a change.

Helping make health care for Californians easy, accessible and reasonably priced
is a great calling. Knowing that your company has channeled over $100 million
back into California communities and will continue to do so is flat out
uplifting. Join the hardest working, not-for-profit health plan in California
and be part of the solution.

The Claims Recovery Manager is responsible for improving claims processing
effectiveness by increasing claims recoveries and identifying the root cause of
claims overpayments. This position will act as a liaison between Claims
Operations, Network Management, HealthCare Services and Corporate Finance and
will lead a cross functional team that will identify and prioritize
opportunities to improve processes that reduce errors and avoid unnecessary
costs.

This position is responsible for analyzing operational and financial data,
network contracts and other data sources to identify and prioritize
opportunities and risks. The manager will provide subject matter expertise to
help resolve questions and/or problems related to contract interpretation,
product/program implementation and claims administration.
The Claims Recovery Manager will support developing and modifying policies and
processes that effect operational performance and that support the Company's
strategic goal of reducing costs.

Requirements

BA degree and eight years related leadership experience and/or training, or
equivalent combination of education and experience

Knowledge of health care operations and broad understanding of the health
insurance industry

Strong interpersonal and communication skills and the ability to interact with
all levels of management, business partners and team members

Requires the ability to change the thinking of, or gain acceptance of others in
sensitive situations

Strong analytical skills and working knowledge of data analysis methods and
procedures along with experience with process improvement methods

Demonstrated ability manage large cross functional projects through to
completion with measurable results

Skill in decision-making, organizational, planning and problem solving

Working knowledge of complex financial systems and system controls

Substantial experience in complex provider negotiations and provider contracting

Blue Shield of CA is an Equal Opportunity Employer.

Our comprehensive benefits begin on your first day with medical, dental and vision coverage; 20 days PTO annually; 9 paid holidays; matching 401(k); and company pension.

Blue Shield of California is an Equal Opportunity Employer.

An Independent Member of the Blue Shield Association.

Blue Shield of California
To Apply for this position, please CLICK HERE