Manager of Configuration and Payment Operations

Job Description

Manager of Configuration and Payment Operations

Manager II – BPM

Who We Are

UST HealthProof is a dynamic company with a mission to lower the cost of care and deliver the future of healthcare. Our consumer-centric approach gives our health plan customers a modern infrastructure and reduced administrative costs, helping to drive better business results for our customers — and better outcomes for our communities.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States. **

You Are**

The Manager of Configuration and Payment Operations is responsible for ensuring the accuracy and timeliness of claims and enrolment plan configuration, testing of the related systems, and overseeing the day to day and overall finance and reconciliation activities for BPaaS clients. Manager will lead a team of benefit, configuration, and finance analysts and will be responsible for performing, developing, analyzing and evaluating configuration performance and the resulting client provider payments, developing the necessary process flows, procedures, and infrastructure to maintain a highly effective and cost-efficient operational model. **

The Opportunity**

• Manage a multi-functional team of onshore and offshore claim, plan configuration and financial analysts and support staff.
• Identifies and develops necessary plans to improve the operational performance for the finance operations area.
• Oversee testing and implementation of changes for claims pricing, benefits and plan configuration within the Ika claims payment and gateway enrolment modules.
• Manage all new configuration requests and changes to existing configuration (including year over year changes), ensuring accuracy and timely delivery.
• Stays current with research, understands, and implements needed changes to meet divisional and regulatory schedules from CMS and other regulatory bodies.
• Edits, corrects, and revises as appropriate.
• Collaborate with business unit leaders and claims department to understand requirements and ensure configuration changes meet business needs.
• Research trending of configuration issues and makes recommendations for improvement.
• Works with the technology team to identify Business requirements to ensure that the Technology solutions meet finance business needs.
• Participates in development of annual departmental budget, monitors budget, and identifies budget discrepancies.
• Research cause and makes recommendations.
• Responsible for balancing team workload to optimize the effectiveness of the department.
• Develops project plans to implement new service delivery model to improve operational performance.
• Represents configuration, payment, and finance operations in all enterprise-wide projects
• Manages and leads all day-to-day functions of the team and holds ultimate accountability for the unit
• Performs or sources project management duties as necessary
• Develops and manages all system access requests related to client needs
• Acts as the lead to represent Operations in the Governance planning meetings
• Serves on the Annual AEP planning committee to ensure all operational needs are met
• Provides guidance and leadership to claims, configuration and financial analysts
• Communicate with Client and Advantasure / USTHP technical resources to ensure effective delivery of configuration, claims processing, and provider reimbursement tasks.

This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required. **

What You Need**

• Bachelor’s degree in Business Administration, Finance, Operations or related field.
• Continuous learning, as defined by the Company’s learning philosophy, is required.
• Certification or progress toward certification is highly preferred and encouraged.
• Seven years of experience in an Finance and/or Claims Configuration with demonstrated technical experience that provides the necessary knowledge, skills, and abilities .
• Three years of supervisory or leadership experience in Finance and/or Claims Configuration is required.
• Previous Medicare Advantage, Health Plan and Managed Care experience preferred.

Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York or Washington as set forth below. **

Role Location: Remote**

Compensation Range: $100,000-$120,000

Our full-time, regular associates are eligible for 401K matching, and vacation accrual and are covered from day 1 for paid sick time, healthcare, dental, vision, life, and disability insurance benefits. **

What We Believe**

We’re proud to embrace the same values that have shaped UST HealthProof since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone, to champion diversity and inclusion, and to place people at the center of everything we do. **

Humility**

We will listen, learn, be empathetic and help selflessly in our interactions with everyone. **

Humanity**

Through business, we will better the lives of those less fortunate than ourselves. **

Integrity**

We honor our commitments and act with responsibility in all our relationships. **

Equal Employment Opportunity Statement**

UST HealthProof is an Equal Opportunity Employer.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.

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