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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.
Diversity and Inclusion : PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.
Supervise and provide leadership and guidance to Claims Analysts and support staff regarding company policies, procedures and workflow applicable to groups / individuals and / or self-funded clients.
Manage claims production and quality that meets or exceeds company standards. Resolve claims adjudication issues. Responsible for hiring, training, coaching, counseling, and evaluating team member performance.
Demonstrate effective leadership by coaching to improve individual performance, develop teamwork and team support, manage change and encourage innovation, build collaborative relationships, encourage involvement and initiative, and develop increased vision and commitment to goals in others.
Essential Responsibilities :
Includes accurate interpretation of benefit and policy provisions for commercial medical and dental, self-funded, individual, conversion, and / or COBRA policies.
Department Management
Supporting Responsibilities :
Work Experience :
Minimum of three years of experience in closely related insurance field or three years' supervisory experience required.
Education, Certificates, Licenses :
Requires high school diploma or equivalent.
Knowledge :
Ability to gain a thorough understanding of PacificSource products, plan designs, provider relationships, and health insurance terminology.
Basic working knowledge of Oregon Insurance Division rules and regulations. Thorough understanding of claims processing system and operation.
Advanced PC skills including, Microsoft Word and Excel. Ability to type using a standard keyboard, operate 10-key pad accurately, multi-line telephone system, and fax machine.
Research skills and ability to evaluate claims in order to audit accurately. Advanced skills in medical terminology, CPT / ICD-10 coding.
Effective and responsive leader. Current knowledge of changes in PacificSource business processes and procedures and relating that information to team members.
Ability to work under time pressures and deal with difficult situations. Team player. Collaborates with others and helps to accomplish objectives.
Strong work ethic and ability to work effectively with a variety of personalities at varying skill levels.
Competencies : Building Trust
Building Trust
Building a Successful Team
Aligning Performance for Success
Building Customer Loyalty
Building Strategic Work Relationships
Continuous Improvement
Decision Making
Facilitating Change
Leveraging Diversity
Driving for Results
Environment :
Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
Skills :
Accountable leadership, Collaboration, Communication (written / verbal), Critical Thinking, Decision Making, Influencing, Listening (active), Organizational skills / Planning and Organization
Our Values
We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business :
Physical Requirements : Stoop and bend. Sit and / or stand for extended periods of time while performing core job functions.
Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English.
Communicate clearly and effectively.
Disclaimer : This job description indicates the general nature and level of work performed by employees within this position and is subject to change.
It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.
Employment remains AT-WILL at all times.
Last updated : 2024-03-27
Full Time
$74k-92k (estimate)
03/28/2024
06/27/2024