This position provides operational & advisory support for the Colorado Region & KPIC Claims Operations. Oversees claims administrations functions through subordinate managers.

Essential Functions:
Support Operations
- Coordinate & facilitate department day to day operations, including claims adjudication, claims research & resolution, training & medical bill review.
- Coordinate weekly/monthly/quarterly leadership team meetings as well as extended team & "all hands' meetings.
- Manages to performance standards that comply w/employer group, regulatory & market requirements.
- Coordinate department budget issues. Coordinate annual budget development process & identify, resolve & escalate (as needed) budgetary issues throughout the year.
- Develops & implements policies & procedures regarding medical claims processing to support regulatory & business requirements for all products offered in the Colorado region.
- Direct & manage the activities of Claims Administration to support financial contracts, state & federal regulations relating to Health Maintenance Organizations, Workers Compensation, No-Fault & Medicare.
- Manage, through subordinate managers, claims adjudication functions. Ensure claims process & results meet accuracy, financial metrics, & timeliness as identified by Kaiser Permanente benchmark standards.
- Ensures claims adjudication process avoids financial and/or compliance penalties.
- Oversees effective, accurate, & timely compliance of medicare claims
- Track & manage issues & action items that emerge in & outside of leadership meetings to ensure timely resolution.
- Coordinate & facilitate the resolution of issues by structuring undefined issues, researching issues, summarizing information & working w/relevant stakeholders to provide information needed to make sound & timely decisions
- Create presentations & research issues as needed to support senior executive preparation for important meetings & events & to help promote agenda
Goal Management
- Facilitate the goal setting process for the department by working closely w/reporting managers to ensure:
Goals are clearly defined & aligned w/the Health Plan leadership objectives & input into performance management system according to deadlines
- Develop & maintain an integrated dashboard to track progress of goals throughout the year.
Manage & track goal performance throughout the year providing regular status to the claims senior management & provide updates to various Health Plan leadership forums as requested
Communication
- Develop & execute department communication strategy, working in partnership w/Business Configuration, KPIC, Network Development & Provider Contracting, Member Services, Member & Benefit Administration & MSSA to support organization's objectives
- Act as a departmental liaison to external departments as requested
- Manages through subordinate managers/supervisors, the following claims functions:
Claims administration, referral processing, claims adjudication, claims research & resolution, claims training, & medical bill review. Oversee both member & provider claims for all Colorado service areas.
Develops & implements policies & procedures regarding claims & referral processing to support regulatory & business requirements for all KP Colorado products.
Works in partnership w/each market's provider contracting staff, utilization management staff & business configuration to develop policies & procedures that support contract administrations & utilization management protocols
- Other duties as assigned