Remote Scouter

At Experian Health, our employees can shape more than products – they shape the future of U.S. healthcare. Experian Health is a pioneer for innovations leading the way in revenue cycle management, identity management, patient engagement, and care management for hospitals, physician groups, labs, pharmacies and other risk-bearing entities. Our success relies on people who are given the freedom to imagine new frontiers in the rapidly changing healthcare space and push the boundaries of innovation. Help us realize our vision of applying data for good and changing the healthcare landscape for the better – for all of us.

Our mission is to use data driven insights to simplify healthcare for all. Simply put, we want to make the healthcare system work better for us as consumers and for those who work in healthcare. Our ONE Experian Health culture is the centerpiece of making this happen. Our aspiration is to bring people together who are driven by purpose and want to make a difference.  We strive to have a diverse group of people and minds who are:

• OPEN: Have a growth mindset and collaborate often with others to make things happen
• NIMBLE:  Always embracing change and pushing the envelope on innovative ways to solve problems
• EFFECTIVE:  Accountable to themselves and to others

The Claims and Remittance Operation manager will lead the team which provides support to both the Claims Clearinghouse and the Remit Clearinghouse. The Claims and Remittance Operation Manager will work closely with data providers, software development, customer support, and business analyst teams and leaders to monitor file activity and investigate all claims or remit related issues. Issues investigated can include: non-delivery of files, incorrect file formats, claim rejection investigations and provider enrollment verification.

Responsibilities:

• Plans, staffs, reviews and organizes subordinate supervisor or staff assignments for a department or major group within a department. Provides leadership, coaching, guidance, training and staff development. 
• Responsible for staff salary planning, personnel actions, and performance management process. 
• Manages departmental financial and operational goals and objectives through subordinate supervisors and staff. May participate with senior management in the development of department budget as well as operational goals and objectives.
• Remains aware of internal company environment, competitive environment, and market trends and developments within functional area. Applies knowledge and provides input to senior management to develop policies and procedures that affect departmental operations and may impact other functional areas.
• Responds to inquiries regarding EDI issues with claims and remits
• Responsible for communicating issues related to claims and remits to internal and external users.  Provides root cause analysis, resolution and documentation on problem tickets (using Salesforce)
• Monitor both the Claim Health Monitor and the ERA Monitor (in-house applications) for errors or problems and determine the appropriate method of investigation to use for troubleshooting the problem
• Track open issues and report to customer support, development, and/or clients until resolution is obtained
• Supports team which provides first level customer support and incident management and that are the primary contact for triage and coordination of claim or remit related issues
• Support file transfer processes for both claims and remits as required
• Act as a liaison between development teams and support teams as well as the payers
• Maintains and distributes reports to customers and partners
• Develop tools and/or utilities to help with the troubleshooting process.

Education and Experience:

• BA/BS or equivalent experience
• 5-7 years functional experience
• 2-3 years managerial experience
• Advanced Healthcare industry knowledge
• Advanced oral and written communication skills
• Advanced customer service skills
• Advanced management and leadership skills
• Advanced project management skills
• Experience in computer operations
• Strong attention to detail and routine tasks and checklists is essential
• General knowledge of TCP/IP networks and experience troubleshooting connectivity issues
• Experience with FTP and secure FTP
• Expertise in creating and running batch files and basic SQL scripts
• General knowledge of health care eligibility and claims data is a plus EDI 27x and 83X transactions.
• Experience with SQL Server 2005/2008 or other RDBMS preferred 

Our goal is to create a thriving, inclusive and diverse team where people love their work and love working together. We believe that diversity, equity and inclusion is essential to our purpose of creating a better tomorrow. We value the uniqueness of every individual and want you to bring your whole, authentic self to work. For us, this is The Power of YOU and it ensures that we live what we believe.

All your information will be kept confidential according to EEO guidelines. Experian is proud to be an Equal Opportunity and Affirmative Action employer. Anyone needing accommodation to complete the interview process should notify the talent acquisition partner.

The word "Experian" is a registered trademark in the EU and other countries and is owned by Experian Ltd. and/or its associated companies.

EOE including Disability/Veterans