Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Director, Provider Claims Resolution
Qualifications:
- Bachelor’s degree in Business Management or related; Master’s degree preferred; additional years of experience/specialized training may be considered in lieu of educational requirements
- 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
- Experience with an enterprise-wide healthcare software/system (that includes automated claims processing, billing, care management and network management workflow, etc.) required, preferably FACETS
- 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 receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.