Claims Manager

Claims Manager

The Department of Medical Assistance Services (DMAS) is excited to offer a competitive opportunity to serve as the Claims Manager in the Program Operations Division. Job responsibilities will include, but are not limited to : This position will have direct oversight of the Claims Unit to include leading and training diverse claims and stakeholder groups and resolving complex claims. Oversee the processing of temporary detention order claims and oversight of the Call Center and Claims portions of the Fiscal Agent Services (FAS) contract in the Program Operations Division. This position will also write and monitor information, maintenance and emergency service requests, participate in system testing, and system implementations for the unit. This position provides individual expertise with internal and external stakeholders throughout the division and agency with respect to the administration of complex claims and billing resolution as needed. This position provides individual expertise throughout the division and agency with respect to the administration of complex policy and procedural requirements associated with Program Operations. Provides the Division Director with support on policy and procedural issues and creates studies and analysis as needed. The business needs for this position have in-office requirements to include but not limited to attending in-person meetings and staff oversight. Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit : https : / / www.virginia.org / The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage. DMAS wants talented individuals who can align their experience with the mission of the agency and its core values service, collaboration, trust, problem solving and adaptability. At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.

Competitive candidates will meet these minimum qualifications : Considerable operational experience in a healthcare claims environment including leading a team of health care professionals. Considerable experience leading claims system implementations and testing. Considerable experience in contract management, health care business processes, project management, and policy development. Considerable experience in planning and implementing large scale / time sensitive operations and projects. Considerable experience with utilizing software programs. Knowledge / Experience interpretation and application of federal, state laws / regulations. Experience in meeting deadlines. Experience with internal / external stakeholders. Experience leading and training stakeholder groups.

Competitive candidates should meet these additional considerations : Considerable knowledge of federal and state regulations governing the administration of Medicaid and related programs.

The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E?Verify Program. The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth's Department of Human Resource Management Policy 1.61 Teleworking. This position could be expected to work in the office as driven by business needs. This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references. This position requires the submission of a Statement of Economic Interest (financial disclosure). If you wish to apply for a job with the Department of Medical Assistance Services, an application and / or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications / resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and / or resume submitted before the closing date. Applications and / or resumes should include relevant work history which indicates your qualifications for this position. The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce. In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link : https : / / www.dars.virginia.gov / drs / cpid / PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155 The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and / or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.

Contact Information

Name : DMAS Talent Acquisition

Phone : 804-225-4407

Email : askhcdtalentacq@dmas.virginia.gov

In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS / DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.