Enterprise Architect at F5 defining and driving enterprise data architecture strategies and overseeing data models, governance, and integration patterns across various domains.
About the role
- Claims Benefit Manager overseeing medical adjudication operations at Hive Health. Leading a team to ensure compliance and optimize claims processing in a hybrid work environment.
Responsibilities
- Lead and manage the medical liaisons team to meet accuracy, quality, and service targets
- Oversee daily adjudication operations to ensure claims are processed efficiently and in compliance with policy guidelines
- Conduct audits to ensure claims accuracy, completeness, and consistency with internal standards
- Identify potential cases of fraud, waste, or abuse (FWA) and coordinate investigations with Legal and Compliance
- Work cross-functionally with Claims, Provider Partnerships and Healthcare Services to address recurring operational issues
- Monitor key metrics such as turnaround time, quality scores, and error rates, and implement corrective measures as needed
- Drive continuous process improvements to enhance provider and member experience in the claims process
Requirements
- Bachelor’s degree in nursing, healthcare management, business, or a related field
- At least 5 years of experience in operations, healthcare administration, or team management
- Strong analytical and problem-solving skills, with a focus on process improvement
- Experience leading teams and driving performance in fast-paced environments
- Comfortable working with data, reports, and digital systems to track metrics and quality outcomes
- Excellent communication and stakeholder management skills across both medical and non-medical teams
Benefits
- comprehensive healthcare coverage for you and your dependent
- paid time off from the start
- mentorship, career development, and learning opportunities
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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