Director Claims Management Ancillary Services (CMAS)
New
C
CentivoHealthcare Insurance
RemoteFull-TimeDirector
Salary$135K - $145K
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Job Details
- Experience
- 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations; 5 years of leadership experience
- Required Skills
- ComplianceHIPAA
Requirements
- 7 years of experience in employee benefits compliance, plan document administration, or healthcare claims operations at a TPA, health plan, or benefits consulting firm.
- 5 years of leadership experience managing managers, supervisors, or teams.
- Deep knowledge of ERISA, the Internal Revenue Code, HIPAA, MSP, COBRA, the ACA, and WHCRA.
- Demonstrated experience overseeing plan document drafting and management (SBCs, SPDs, SMMs) in a self-funded or TPA environment.
- Demonstrated experience overseeing claims audit, appeals, recoveries, subrogation, NSA, or quality assurance functions.
- Strong data literacy and ability to interpret operational and quality metrics.
- Bachelor's degree required.
- Experience partnering with Legal, Compliance, Configuration, and Client Success teams.
- Paralegal certification or advanced degree in a relevant discipline preferred.
Responsibilities
- Own the strategy, quality, and regulatory compliance of plan document functions including SPDs, SMMs, plan amendments, and SBCs.
- Ensure processes remain compliant with ERISA, HIPAA, MSP, COBRA, ACA, and WHCRA.
- Manage the end-to-end performance of claims audit, appeals, escalations, recoveries, subrogation, and No Surprises Act (NSA) functions.
- Direct workforce and capacity planning, including inventory management, resource allocation, and oversight of KPIs.
- Drive process improvement, workflow standardization, and automation initiatives.
- Manage the Plan Documents Manager and CMAS Manager, providing coaching and performance development.
- Represent CMAS and Plan Documents in cross-functional meetings and discussions with clients, brokers, and stop loss carriers.
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