Job Description

Job Responsibilities

The Agency\'s mission is to be boldly innovative in improving the health and quality of life for South Carolinians.

This is position is located in the Office of Claims Resolution, Richland County.

Are you the One? We are looking for a Program Manager I who reports directly to the Director of the Office of Claims Resolution and is an integral member of the Claims Resolution Leadership Team. They will manage Medicaid claims and stakeholder escalations within the Office of Claims Resolution in accordance with all policies and procedures. Investigate, define and resolve complex claims processing issues. Maintain a thorough knowledge and understanding of claims processing, provider/member relations and industry standards. Understand, foster and practice high customer service standards. Communicate complex information to both technical and non-technical audiences. Facilitate collaboration between stakeholders. Supervise staff responsible for processing claims and escalations. Establish milestones and assigns staff tasks and responsibilities. Analyze, design, plan, execute, and evaluate claims processing work against time and quality targets. They also have direct responsibility for the performance of their claims section/staff.

• Communicates and shares pertinent and timely information to direct reports by holding team meetings, scheduling regular 1:1 employee discussion, reinforcing leadership messages. Directly supervises Claims Resolution Staff. Carries out management responsibilities in accordance with the organization\'s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; establish performance standards; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Demonstrates leadership by serving as a positive role model and creates an environment of team engagement. Ensures open communication with team and maintains an open-door policy for employee engagement, communication, and coaching.
• Ensure that departmental productivity, compliance and quality standards are met. Contributes to the achievement of business results by ensuring that claims are effectively handled according to company protocols, quality and customer service standards are achieved. Manages the development and maintenance of desktop processes, policies and procedures for all lines of business to ensure compliance with regulatory agencies. Identify problems, define alternatives and recommend solutions for process improvements. Develop and implement analytical tools to identify department trends and will manage dedicated resources for the day-to-day operations of the following processes.
• Builds and maintains collaborative relationships with internal and external partners. Openly and consistently communicate with other departments and vendors. Works in conjunction with other departments whose functions directly influence/impact claims processes. Works in conjunction with the other Claims Resolution Program Managers and Claims Director to identify process improvement opportunities to increase department efficiency.
• Determines the required outcomes for individual and team learning or development. Mentors assigned staff, ensuring alignment with Director and Bureau Chief statements of required development outcomes. Creates development plans for individual staff. Assures cross training of staff for team in the Office of Claims Resolution as well as within The Bureau of Provider & Support Services; documents cross training as part of individual staff developmental plans. Monitors staff progress toward continuing professional development. Ensures professional development is accurately measured and recorded on individual staff performance appraisals.
• Functions as the back-up for other claims management, as necessary. Complete other projects and duties as assigned.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children.
• 15 days annual (vacation) leave per year.
• 15 days sick leave per year.
• 13 paid holidays.
• State Retirement Plan and Deferred Compensation Programs.

Minimum and Additional Requirements

A high school diploma and seven (7) years of direct supervision experience of staff OR

A bachelor\'s degree and three (3) years of direct supervision experience of staff.

PREFERRED: Supervision of staff in acute care claims payment operations.

Additional Requirements:

• Occasional overnight travel.
• Sitting or standing for long periods of time.

Preferred Qualifications

• Knowledge of the SCDHHS mission, programs and objectives.
• Knowledge of the SCDHHS organizational structure, the people who manage the work and the processes applicable claims and provider related services.
• Ability to manage work and provide guidance to employees.
• Proficiency in Microsoft Office and internet/web navigation.
• Ability to work independently and also in a team environment.
• Strong organizational, time management, and interpersonal skills.
• Ability to interpret and apply rules and regulations.
• Excellent analytical and problem-solving skills.
• Ability to professionally interact, develop and manage relationships with a multiple levels and departments.
• Excellent written and verbal communication skills.
• Healthcare claims processing preferred.

Additional Comments

Please complete the State application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position. Supplemental questions are considered part of your official application for qualification purposes. All applicants must apply online. All correspondence from the Office of Human Resources will be through electronic mail.

The South Carolina Department of Health and Human Services is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

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