Claims Director

3 weeks ago(12/30/2017 8:35 AM)
Requisition ID
# of Openings
Job Function
Job Schedule
Regular Full-Time


This position will support delivery of services centered on payment of fee-for-service claims processing.


  • Principal manager over the claim processing operations
  • Review cases to determine and summarize facts of each case assigned and assesses issues involved in the case
  • Research issues using federal law, federal regulations, relevant contract law and other sources as defined by the client contract
  • Review plan contracts and other relevant information and then make a decision as to whether an enrollee is entitled to benefits in cases involving contractual disputes
  • Communicate the determination in a clearly written format
  • Exercise independent judgment to ensure determination is accurate, well-supported and defensible and take appropriate action as required
  • Research issues using federal law, federal regulations, relevant contract law and other sources as defined by the client contract
  • Perform other duties as may be assigned by Management
  • Acquire all necessary information involving information and render final determination based on the information provided by the beneficiary

The Ideal Candidate will Possess the Following Additional Education and Experience

  • A Bachelor’s degree and a minimum of four (4) years’ experience managing healthcare claims processing operations and personnel for a government or private sector health care payer. Additional relevant management experience may substitute for the degree on a year-for-year basis.
  • Supervisory/administrative experience in the execution and/or evaluation of program policies.
  • Excellent verbal, written, and presentation communications skills.
  • Ability to successfully execute many complex tasks simultaneously
  • Ability to respond to the needs of outside contacts
  • Working knowledge and use of PC, claim adjudication, MS Word and Excel software, and appeals system software
  • Demonstrate teamwork and promote positive company relations
  • Excellent organizational, interpersonal, written and verbal communication skills

EEO Statement

EEO Statement
Active military service members, their spouses, and veteran candidates often embody the core competencies MAXIMUS deems essential, and bring a resiliency and dependability that greatly enhances our workforce. We recognize your unique skills and experiences, and want to provide you with a career path that allows you to continue making a difference for our country. We’re proud of our connections to organizations dedicated to serving veterans and their families. If you are transitioning from military to civilian life, have prior service, are a retired veteran or a member of the National Guard or Reserves, or a spouse of an active military service member, we have challenging and rewarding career opportunities available for you

A committed and diverse workforce is our most important resource.

MAXIMUS is an Affirmative Action/Equal Opportunity Employer.

MAXIMUS provides equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status or disabled status.


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