Job Details

Responsibilities

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.

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Job Summary:

The Senior Claims Manager is responsible for leading and managing the day-to-day operations of the claims department with a focus on accuracy, compliance, and efficiency. This role plays a critical part in ensuring that all claims are processed in accordance with federal, state, and payer requirements while delivering a high level of service to providers, members, and internal stakeholders. The Senior Claims Manager will oversee a team of claims staff, providing leadership, training, and guidance to drive performance and accountability. In addition to managing operations, this position will collaborate with cross-functional teams to identify process improvements, ensure compliance with Medicare regulations, and leverage technology to optimize claims workflows. The ideal candidate will bring strong Medicare claims experience, working knowledge of claims adjudication systems (with QNXT experience preferred), and the ability to balance operational oversight with strategic initiatives that enhance quality, turnaround times, and overall departmental success.

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

Qualifications and Requirements:

• Bachelor's degree in health care administration or business management, or equivalent work experience.
• 5+ years' experience in claims management with direct Medicare claims experience.
• 5+ years' experience managing, budgeting, forecasting and collaboration with executive leadership.
• Strong leadership skills with an ability to influence and persuade internally and externally while driving cross-functional collaboration.
• In-depth knowledge of medical terminology, coding systems (CPT, ICD-10), and insurance billing practices.
• Strong understanding of healthcare regulations, including HIPAA, CMS guidelines, state laws and experience in information preparation for required regulatory audits.
• Ability to promote data driven decision making throughout the organization.
• Knowledge of benefits, pricing and inventory management and reporting.
• Expertise in software implementation, technology adoption and an understanding of which tools work best to meet the needs of organization.
• Outstanding interpersonal skills
• Excellent written, oral, and active listening communication skills.
• Proficient in MS Office, contact center and training platforms, workforce management and project/team management software.
• Strong project management skills and experience managing large scale projects.
• Knowledge of claims systems and processed, QNXT system experience strongly preferred.
• Ability to effectively communicate in English, both verbally and in writing.
• Excellent computer skills.
• Highly developed professional, interpersonal, written and oral communication skills.
• Experience in building and maintain provider relationships.
• Highly accountable, organized, detailed

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.

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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.

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