Bailey Finch - Recruitment Associates
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Recovery & Resolutions Manager

Job Id: 594

Contact: Tina Jennings

Salary: 55k euros

Contract Term: Permanent

Contract Type: Full Time

Expires: 18 June 2016

Location:

The Manager Recovery/Resolutions position oversees the following functions: claims processing, project management, Medical and Reimbursement policy, staff management/supervision,

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers . May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to  compliance policies, reimbursement policies and contract compliance.
Core competencies for this role include:
  • Leads and operates in a progressive People management environment
  • Operates in a highly regulated quality driven organization
  • Operations excellence through daily operations management (Key Metric Indicators / Management By Objectives)
  • Operating in a matrix environment  with multiple stakeholders
  • Reporting  on performance against targets – daily/weekly/monthly
  • Developing recovering plans for gaps to target
  • Leads on implementing continuous improvements  through recovery plans as required or strategic improvements
Primary Responsibilities:
  • Supervise and oversee metrics and daily production for Clinical Investigators
  • Ensure all internal/external customer business expectations are met
  • Responsible for review and development of policy and procedures tailored to the clients/products
  • Ensure the cases are processed in accordance with reimbursement and medical policies
  • Develop new processes and process maps for Clinical Operations
  • Driving process improvements and increasing the teams overall productivity
  • Ensure compliance with state regulations
  • Responsible for the oversight of quality
  • This person will be responsible for building and maintaining relationships with multiple areas that assist in the work that we do. There is also an urgency to get work done due to interest penalties and prompt pay guidelines.
  • Manages and is accountable for professional employees and/or supervisors.

 

Required Qualifications and Experience:
  • Bachelor's Degree in related areas and or experience in Healthcare insurance/financial services industry (or equivalent work experience)
  • 3 years’ experience in a financial service industry, preferably in claims and/or audit/recovery role.
  • 3 years of experience Reporting  on performance against targets – daily/weekly/monthly: analyzing key performance indicator trends for all operational areas including P&L
  • 3 years of experience in Operations excellence through daily operations management (Key Metric Indicators / Management By Objectives) : establishing operational scorecards and appropriate business targets, budgets and forecasting based on analysis.  Developing recovering plans for gaps to target
  • 3-5 years of experience in Leading and operating in a progressive People management environment and/or  Operating in a matrix environment  with multiple stakeholders
  • 3+ years of experience Operating in a highly regulated quality driven organization
  • 2+ years of experience Leads on implementing continuous improvements  through recovery plans as required or strategic improvements
  • Advanced Microsoft Office skills with Excel, PowerPoint