Communitycare Of Oklahoma Work Values

Daily Duties at Communitycare Of Oklahoma:

Senior Manager, Claims Administration Lead strategy, business development, streamlined payment outcomes and staffing development at a large healthcare plan through collaboration with internal executives, department heads and mid-level staff and external members including hospitals, physician offices and other healthcare professional; accountable for hiring, coaching/training, disciplinary actions and termination. Reduced average employee turn-over rate from 35% to less than 8%, including several years of zero turn-over. The claims department processed over 2M claims annually, maintaining over 99% accuracy rate while averaging better than a 12-day turn-around time for claims received to paid; established ‘best practices’ for handling coordination and recovery of third-party liability, workers compensation and COB (Coordination of Benefits) claims; improved office efficiencies by 10% annually (over past three years) by developing and monitoring business processes built around competitive production and quality guidelines and increasing automation efficiencies related to claims processing by consistently increasing auto-adjudication; prepared and managed departmental budget of over $2M (reviewing monthly while averaging a 5% reduction over past three years.) Manager, HMO Claims Managed large claims processing staff towards more efficient workflows and processes, reducing the existing claim inventory from over 50,000 and forty-five-day claim turn-around to an inventory of less than 15,000 and an average turn-around to less than 15 days. This was completed within 1 year; drove annual costs savings of over $500K by capturing and analyzing health care data to identify trends and opportunities for cost savings and potential fraud, waste and abuse, including collaboration with medical staff related to clinical criteria and interpretation; directed process improvement initiatives to identify and implement best practices to improve satisfaction for both internal and external customers; member of committee that created, assigned and interpreted benefits for all managed care plans sold, including coverage criteria determinations and application of state and federal requirements.

What they like about Communitycare Of Oklahoma:

You give high priority to hiring firms with prestige. Market reputation and prestige of a firm may be determined through on-line research, and conversations with individuals working in your target industry. Note that firms "in the public eye" receive a great deal more critical publicity and attention than those operating with more anonymity. So as you assess your employment opportunities, be sure to seek out the positive aspects of the firm's reputation in addition to noting negative publicity the company may have received.

Tags

Claim Processing, SQL, Microsoft Office, Data Analysis, Contract Negotiations, Benefit Interpretation, Vendor Contract Management, Management, Communication, Teamwork, Problem Solving, Customer Service, Process Improvement

Skills

Quality Management, Problem Solving, Customer Service, Decision Making, Process Improvement, Time Management, Leadership, Teamwork, Communication, Contract Negotiations, Independent

These are some of the questions we asked our climbers about their experiences with Communitycare Of Oklahoma: