OS
Section Director managing equity and policy initiatives to eliminate health inequities at Oregon Health Authority. Leading strategic programs and collaborations to improve health outcomes for Oregonians.
About the role
- Claims Administration Director leading claims management activities and ensuring quality control. Responsible for operations and collaboration with various departments to achieve strategic goals.
Responsibilities
- Provides leadership and direction for the Claims Administration team
- Ensures claims are processed for payment accurately and timely
- Identifies and resolves operational issues using documented processes
- Serves as expert in provider billing, reimbursement, and encounter reconciliation
- Collaborates with Vaya business teams to support operational improvement
- Reviews and provides leadership for handling unusual claims or eligibility issues
- Monitors claims activities and ensures compliance with policies
Requirements
- Bachelor’s degree in Business Administration, Accounting, Finance, Healthcare, Human Services or related field required
- 10 years of claims processing experience; supervisory role with increased responsibilities over time
- Extensive knowledge of claims management, Medicaid, and State funding rules and regulations, third-party payer, and coordination of benefits
- Knowledge of a capitated managed care environment
- Strong focus on the people side of change
- Proficiency in Microsoft products to include Excel and Outlook
Benefits
- Health insurance
- 401(k) matching
- Paid time off
- Flexible work arrangements
- Professional development opportunities
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