Sr. Manager of Operations - Claims

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Learn more at: https://prominence-health.com/

Job Summary:

The Sr. Operations Manager is responsible for management of Prominence Health Plan operations and select vendor relationships. The Sr. Operations Manager will direct strategic initiatives to realize efficiencies, and outstanding customer service to Prominence Health Plan clients, brokers, vendors, providers and members as well as to ensure that operational goals and measures are met.

Responsible for gathering and validating requirements, coordinating tasks, regular communication, identifying appropriate resources needed to development and implementation of significant initiatives within the organization in support of Senior Management.

The Sr. Operations Manager oversees and manages the operational and strategic aspects of assigned projects and initiatives, tracks project risks, opportunities and issues in order to develop resolutions to meet quality and timeline goals and objectives.

The Sr. Operations Manager will be responsible for managing of key operational departments and have responsibility across all three lines of business. Responsibilities also include being the lead operational liaison connecting market based leadership to centralized operations and support directing oversight of a remote workforce.

Benefit Highlights:

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive Compensation & Generous Paid Time Off
• Excellent Medical, Dental, Vision and Prescription Drug Plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ Subsidiaries! * More information is available on our Benefits Guest Website: benefits.uhsguest.com

About Universal Health Services:

One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World's Most Admired Companies by Fortune; and listed in Forbes ranking of America's Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. www.uhs.com

Qualifications and Requirements:

Regulatory Requirements:

• Bachelor's Degree in Business or related Health Care degree, MBA, or Masters in Public Health.
• Five years of Operations Management experience working within the Healthcare Insurance industry required.
• Knowledge of computer systems, experience using databases, and demonstrated proficiency in a variety of computer applications.
• Working knowledge of NCQA process for standards applicable to UM/QI.

Language Skills:

• Ability to effectively communicate in English, both verbally and in writing.

Skills:

• Ability to convey goals and objectives clearly and in a compelling manner; listen effectively and clarify as needed; confirm all verbal messaging via written document; produce clear status reports; communicate tactfully and candidly.
• Confidence in decision-making. Can-do attitude.
• Excellent interpersonal, oral and written communication skills.
• Strong analytical ability, excellent communication skills, with the ability to manage projects and multiple priorities at the same time.
• Self-motivated and able to provide results with minimal supervision.
• Experience in managing multiple project and reporting.
• Must understand data specifications and requirements for reporting needs.
• Experience in working with data, understand data structures/relationships, data field types, causes for data integrity and reporting issues.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Avoid and Report Recruitment Scams

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skill set and experience with the best possible career path at UHS

and our subsidiaries. During the recruitment process, no recruiter or employee will request financial or personal information (e.g., Social Security Number, credit card or bank information, etc.) from you via email. Our recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc.

If you suspect a fraudulent job posting or job-related email mentioning UHS or its subsidiaries, we encourage you to report such concerns to appropriate law enforcement. We encourage you to refer to legitimate UHS and UHS subsidiary career websites to verify job opportunities and not rely on unsolicited calls from recruiters.