Manager Operations EOB and Audit
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Job Summary
The Manager Operations EOB and Auditing reports directly to the Director of Claims and Performance Auditing. Responsibilities include Managing all EOB functions from development to implementation for all Lines of Business. Conducting auditing from Claims adjudication through disbursement to ensure accurate EOB data population and display. Support Self Funded Group EOB development to meet the needs of the group and members.
Responsibilities
- Accountable for managing the Claims EOB project oversight and reporting
- Engage Operation’s leadership to define, prioritize and manage project needs and reporting and data needs to solve business problems and make informed decisions.
- Engage across the Organization to deliver Claims Operation’s EOB data and auditing needs.
- Accountable for EOB data mapping and providing business analysis to identify regulatory and business needs and work with Operation’s leadership to define business solutions.
- Accountable for modeling operational impacts based on operational metric projections and scenarios (member, provider, claim etc.)
- Manage the assigned Claims EOB Operations Business Analyst staff and activities.
- Devise and maintain all EOB project reports for management and business partners and ensure their transparency and understanding by the user clients.
- Translate project data into trends and projections of operational and financial performance.
- Target and propose EOB operational areas for continuous improvement and efficiency.
- Collaborate with client leadership to understand business performance to provide support for business decisions.
Qualifications
· 5 years of Operational business analytics and auditing, experience.
· 5 plus years in leadership roles
· Eight (8) or more years of progressively more responsible experience in Operations Analysis, or comparable discipline and business activity.
Inclusion and Belonging
At AmeriHealth, everyone can feel valued, supported, and comfortable to be themselves, and all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. Celebrating and embracing diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At AmeriHealth, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
AmeriHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an AmeriHealth employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of AmeriHealth and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by AmeriHealth or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.