Job description

100% Remote

Job Post: Claims Administration Manager

Duration: 03 Months

Location: 6621 Fannin St, MC Houston Texas 77030

Pay Rate:$35-40/hr on W2(No Benefits)

Must Have :

1) Have you taken COVID vaccination with Booster:

2) Do you have Immunizations vaccination track record of MMR, TDap, Varicella, Hep B:

Job Description

Duties:

To plan, develop and implement Claims processing functions and related processes for the Claims Administration Department
of Health Plan. This position will have key responsibility for the integrity of the claims payment and
adjudication process. This position will be responsible for ensuring that claims are processed accurately and timely for
reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits
as specified in the member evidence of coverage. Health Plan processes 225,000 plus claims on an annual
basis representing approximately (USD)32 million dollars paid.
Plan, develop, organize and implement processes to ensure timely and accurate claims processing.
Plan, develop, organize and implement processes to ensure claim adjustments, appeals and correspondence is completed
timely and accurately.
Develop policies and procedures and for a Pediatric HMO which are based on the integrated delivery system goals and
objectives and which meet the performance goals and measurements.

To plan, develop and implement Claims processing functions and related processes for the Claims Administration Department
of Health Plan. This position will have key responsibility for the integrity of the claims payment and
adjudication process. This position will be responsible for ensuring that claims are processed accurately and timely for
reimbursement to the Health Plan Providers and members, in accordance with contracted fee schedules and covered benefits
as specified in the member evidence of coverage. Health Plan processes 225,000 plus claims on an annual
basis representing approximately (USD)32 million dollars paid.
Plan, develop, organize and implement processes to ensure timely and accurate claims processing.
Plan, develop, organize and implement processes to ensure claim adjustments, appeals and correspondence is completed
timely and accurately.
Develop policies and procedures and for a Pediatric HMO which are based on the integrated delivery system goals and
objectives and which meet the performance goals and measurements.

Skills:

• Texas Department of Insurance regulations pertaining to HMOs
• Statutory reporting requirements of HMOs
• Claims processing requirements and general principles
• Systems implementation and maintenance
• Managerial skills
• Process flow development
• Organizational skills

Education:

Required- H.S. Diploma or equivalent
Required- 7 years Health Plan claims administration or related experience
Bachelor's degree with substitute for four (4) of the required years of experience

Job Types: Full-time, Contract

Salary: $30.00 - $40.00 per hour

Schedule:

• 8 hour shift

Application Question(s):

• 1) Have you taken COVID vaccination with Booster:

2) Do you have Immunizations vaccination track record of MMR, TDap, Varicella, Hep B:

Education:

• Bachelor's (Required)

Experience:

• Claims Administration: 5 years (Required)
• Texas Department of Insurance regulations pertaining to HMOs: 1 year (Required)
• Statutory reporting requirements of HMOs: 1 year (Required)

Work Location: Remote

Speak with the employer
+91 +18325090762

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