Job Description

HealthPartners is hiring a Claims Cost Senior Manager to manage a comprehensive claim cost containment area for HealthPartners. This role provides direct administrative support to Claims Department processes, new business initiatives and participates in the development and implementation of key Administrative Systems projects and strategic operational initiatives. They will work directly with all levels of staff within the organization, providing leadership for administrative functions.

ACCOUNTABILITIES

• Responsible for the supervision of staff, including having the authority to hire, transfer, lay off, promote, discipline and discharge, train, reward and review performance of employees. Ensures compliance to organizational and departmental policies and procedures.
• Provides management leadership for designated administrative areas. Facilitates communication with business functional leaders. IS, staff, officers and senior management, regarding operational and functional area development, impact analysis of new business initiatives, regulatory
• Directs the analysis of complex business operations, defines requirements. Performs feasibility studies and produces cost/benefit information, and completes requirement analysis.
• Ensures optimum benefit dollar recovery through third party liability provisions and claim refund activity.
• Develop recovery theory and investigative potential overpayments, and assess potential for financial recovery.
• Identify recovery opportunities through the detailed review of informational and data sources.
• Contribute to the development of operational processes within the team as well as policies and procedures.
• Identify critical issues needing resolution. If issues require senior management attention, work with each as necessary to address changes and strategic projects.
• Provides leadership for affordability and customer driven initiatives.
• Serve as administrative expert including for functional area(s) and issues related to Claims
• Represent HealthPartners in dealing with external and internal audit firms and other outside organizations.

• Meet or exceed targets established for recoveries.

• REQUIRED QUALIFICATIONS
• Bachelors Degree
• 7-10 Years of related experience within a regulatory and or healthcare compliance environment preferred.
• Ability to search out and identify recovery and cost containment opportunities
• Effective leadership, change management and judgment skills
• Excellent communication skills; verbal, written skills
• Ability to establish positive relationships internally and with industry groups and regulatory agencies.
• Solid business acumen and good understanding of business processes and dependencies
• Healthcare data analysis experience.
• Strong customer focus and negotiation skills.
• Demonstrated skill in planning, organizing and time management.
• Ability to analyze and interpret data and communicate action plans.
  

PREFERRED QUALIFICATIONS

• Masters degree in business administration, or other health-related field
  

DECISION-MAKING:

• Administrative division budget and priorities developed by the Vice President of Administration, Administrative Business Department Directors.
  
• This Manager will need to balance and manage multiple products and projects. External and Internal customers depend directly on the leadership and direction of this position
• This position will have broad latitude in direction and influencing the use of resources to achieve key performance indicator requirements. This position will operate with a high degree of independence in the execution of the function(s) responsibilities.
  
• Staff recruitment, retention, and training.

At HealthPartners we believe in the power of good – good deeds and good people working together. As part of our team, you’ll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We’re a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We’re working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health
As a HealthPartners colleague, we’re committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.