Company Statement
For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.
AVP, Provider Claim Resolution
Qualifications:
- Bachelor’s degree in Business Management or related; Master’s degree preferred.
- Six Sigma / Project Management certification preferred.
- 10+ years of experience managing high volume HMO and/or PPO health insurance claims processing function across Commercial, Medicare and Medicaid segments. (Required)
- Additional years of experience/specialized training may be considered in lieu of educational requirements. (Required)
- Experience with an enterprise-wide healthcare software/system (that includes automated claims processing, billing, care management and network management workflow, etc.), preferably FACETS. (Required)
- Strong knowledge of contract requirements, provisions, SLAs, metrics, terms, and other parameters that impact/measure overall performance and compliance; and the ability to negotiate contract terms. (Required)
- Analytical skills with emphasis on generation and utilization of data to drive operational and financial performance. (Required)
- Ability to identify, quantify, and analyze problems; and to develop, recommend, and implement solutions effectively. (Required)
- Critical “end-to-end” thinker and business problem solver who moves quickly and decisively. (Required)
- Strong interpersonal, problem solving and project/time management skills. (Required)
- Excellent communication skills (verbal, written, interpersonal) with all internal/external audiences. (Required)
- Ability to effectively develop and deliver presentations to all levels within and outside of Emblem. (Required)
- Ability to work in a complex, rapidly evolving environment with multiple internal and external entities and boundaries. (Required)
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives, and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.
Sponsorship Statement
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.