About Us
McLaren Health Care is a fully integrated health network committed to quality, evidence-based patient care with locations in Michigan and Indiana. The McLaren system includes 13 hospitals in Michigan, ambulatory surgery centers, imaging centers, a primary and specialty care physician network, commercial and Medicaid HMOs, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, one of only 53 National Cancer Institute-designated comprehensive cancer centers in the U.S.
Manager, MIG Claims - Michigan
We are looking for a MIG Manager Claims, to join us in leading our organization forward.
McLaren Integrated HMO Group (MIG) is a fully owned subsidiary of McLaren Health Care Corporation and is the parent company of McLaren Health Plan in Michigan and MDwise, Inc. in Indiana. It is an organization with a culture of high performance and a mission to help people live healthier and more satisfying lives.
McLaren Health Plan and MDwise, Inc., subsidiaries of MIG, value the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plans can thrive. As an employee of MIG, you will be a part of a dynamic organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.
McLaren Health Plan is our Michigan-based health plan dedicated to meeting the health care needs of each of our Michigan members. Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org.
MDwise is our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs. Learn more about MDwise, Inc. at https://www.mdwise.org/.
Position Summary:
Provides overall management in providing superior claims operations for McLaren Integrated HMO Group’s health plan subsidiaries (HP). Specific areas of responsibility include, but not limited to, claims administration, administering and maintaining the claims module, payment integrity and recovery operations, and identifying and addressing provider payment discrepancies. Develops and implements policies and procedures to promote the operational integrity for HP. Coordinates interdepartmental reports and statistics for senior management, state regulators, compliance, and accrediting agencies. Responsible to analyze, develop and implement training programs and procedures for operational staff. Designs, implements and adjusts workflows to ensure departmental efficiencies are maintained. Responsible for monitoring staff performance relative to departmental standards and designing corrective action plans as necessary.
This is a hybrid position with requirements to come onsite as scheduled, Flint, MI.
Equal Opportunity Employer of Minorities/Females/Disabled/Veterans
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Qualifications:
Required:
- Bachelor’s Degree in health care, business, or related field.
- Five (5) years progressive experience in a leadership role leading including three (3) years’ experience in a supervisor role leading a professional staff of five or more members in all phases of effective supervision (ie. Recruitment, performance management, training).
- Four (4) years’ experience in health plan claims, billing or claims adjudication operations for multiple subsidiaries or business units.
Preferred:
- Certification as appropriate to position.
- Five (5) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, claims processing, membership/eligibility)
- Affiliation with a Professional Organization.
Equal Opportunity Employer
McLaren Health Care is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identification, age, sex, marital status, national origin, disability, genetic information, height or weight, protected veteran or other classification protected by law.
