Claims Analyst

Claims Processing Department Supervisor

Samaritan Health Plans (SHP) operates a portfolio of health plan products under several different legal structures: InterCommunity Health Plans, Inc. (IHN) is designated as a regional Coordinated Care Organization (CCO) for Medicaid beneficiaries; Samaritan Health Plans, Inc. offers Medicare Advantage and Commercial Large Group plans. As part of an Integrated Delivery System, Samaritan Health Plans is strategically and operationally aligned with Samaritan Health Services' mission of Building Healthier Communities Together.

This is a remote position in which we are able to employ in the following states: Alabama, Alaska, Arizona, Arkansas, Connecticut, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, or Wisconsin.

Job Summary/Purpose

Responsible for the organization and supervision of the Claims Processing Department and mail room for Samaritan Health Plans (SHP). Provides leadership in setting and maintaining standards for the management of the department, ensuring compliance to the operational benchmarks established by department leadership.

Experience/Education/Qualifications

• High School Diploma or equivalent required.
• Four (4) years experience in a claims related role requiring claims adjudication, benefits analysis, coordination of benefits and/or third-party payer liability required.
• Two (2) years leadership experience required.

Knowledge/Skills/Abilities

• Effective written and verbal communication skills to perform group presentations, tactfully discuss issues, and listen to and understand concepts, rules and procedures. Ability to work with all levels within the organization, facilitate communication, and effectively document related activities.
• Ability to identify complex problems, review related information, employ creativity and alternative thinking to develop and evaluate options and implement solutions.
• Leadership - Inspires, motivates, and guides others toward accomplishing goals. Achieves desired results through effective people management.

Physical Demands

• Rarely (1 - 10% of the time) - Occasionally (11 - 33% of the time) - Frequently (34 - 66% of the time) - Continually (67 – 100% of the time)
• CLIMB - STAIRSLIFT (Floor to Waist: 0"-36") 0 - 20 LbsLIFT (Knee to chest: 24"-54") 0 – 20 LbsLIFT (Waist to Eye: up to 54") 0 - 20 LbsCARRY 1-handed, 0 - 20 poundsBEND FORWARD at waistKNEEL (on knees) - STANDWALK – LEVEL SURFACEROTATE TRUNK StandingREACH - UpwardPUSH (0 - 20 pounds force)PULL (0 - 20 pounds force) - SITCARRY 2-handed, 0 - 20 poundsROTATE TRUNK SittingREACH - Forward - MANUAL DEXTERITY Hands/wristsFINGER DEXTERITYPINCH FingersGRASP Hand/Fist