Description
Senior Claims Manager
Duration- 3months +
Location: Francis Crick House, Northampton
Inside IR35
Sopra Steria Recruitment is working in partnership with a major public sector in the UK. We are currently recruiting Senior Claims Manager for 3+months contract initially with possible extension.
The Senior Claims Manager will support the Head of Operational Claims Management with the delivery and development of the Operational Claims Management process, including the monthly Claims cycle and managing the relationships with local POD teams.
The post holder will have line management responsibilities for the Operational side of the team and will manage all operational aspects of the monthly Claims cycle, together with the ongoing development of the Claims Team and Claims Process.
Job Description:
- Line management responsibility for the Claims Managers, Senior Claims Leads and Claims Co-ordinators.
- Work closely with Contract Leads and the Claims Systems Manager to ensure that Provider submitted data is fit for purpose
- Support the Head of Operational Claims Management to manage the end to end monthly cycle, including the review of data from multiple sources, identification of claims and flag potential mischarged activity and the review of automated claims prior to the claims submission via the generated provider templates and reports
- Responsible for ensuring that the Claims process operates within the agreed timetable
- Responsible for the management of the Claims team in ensuring collaborative working with the MDT teams and to co-ordinate the efforts of claims management and the NTPS challenge process to ensure maximum financial returns for lowest costs, including monthly reviews of claims and attendance at CCG/Provider meetings when required
Required Skills
- Ensure that Claims are developed in-line with the National Tariff Payment System (NTPS) and local and national contractual rules and guidance
- Support the Head of Claims Management in providing an in-house source of knowledge and expertise on NTPS
- Support the Claims Technical Team in the maintenance and development of the Claims Management area of NELIE, a web-based Business Intelligence platform for customers and internal CSU staff.
- Communication of formal and complex presentations to large groups and senior audiences
- Work with different stakeholders (CCGs, Local Authorities, Trusts) to ensure the claims system and process is understood and the often highly complex results are communicated and explained clearly
- Act as Claims lead for designated provider contracts, working closely with senior Contracting, Finance and Analytics staff, and attending meetings with Trust and CCG representatives to ensure maximum claim yield and timely resolutions of claims
- Analysis and interpretation of complex statistical data relating to trends, patterns and anomalies
- Collate and present information with accuracy, timeframe and ensuring it is fit for purpose
- Providing technical support to commissioners to ensure that health intelligence and information are
- Training and developing staff in key skills associated with health intelligence
- Lead the quarterly Claims reconciliation process, monthly claims reporting process and facilitate the overall Finance and Contracting reconciliations including making recommendations of the likely claims yield dations of the likely claims yield