Be inspired. Be rewarded. Belong. At Emory Healthcare.
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide:
Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs And moreWork Location: Atlanta, GA
Description Plays a key role in protecting the financial stability of Emory University, Emory Healthcare, and its wholly owned insurance subsidiary, Clifton Casualty Insurance Co. Ltd. (CCIC)Processes and monitors claim related payments and assures monthly reconciliation for EHC, CCIC, and its actuaryManages the monthly indemnity and legal expense payment process for Medical Professional, General Liability and Network Security & Privacy matters payable under the Emory Liability Insurance Program through CCICTracks and creates monthly loss runs which tracks all payment and reserve related movement for third party liability matters insured under CCICThis role also has claims data analytics components, responsibility for analyzing insurance claims data for reporting purposes, to find trends, and support decisionsThe Claim Financial Process Manager will collect data, perform statistical analysis, create dashboards/ reports and collaborate with teams including Claims, Risk, Patient Safety, Quality, and Clinical operating unitsThe goal is to bring awareness to claims holistically to help inform risk, patient safety and quality initiatives, ultimately to improve patient outcomes and reduce claims and claim costsManagement of Financial processes for CCIC:Manages time-sensitive monthly financial data processes, including inputting initial reserves and reserve changes, case settlements, legal and related vendor invoices, monthly accounting reconciliation and balancing, and fiscal year end closingResponsible for running and balancing the monthly loss runs for CCICData Analysis & Reporting:Collect, validate, normalize, and analyze medical professional and general liability claim dataDevelop, maintain, and run standard and ad hoc reports, including but not limited to monthly loss runs, transaction reports, and trend and severity analysesUpdate tower erosion and exhaustion reports to track aggregate losses, paid/incurred amounts, and remaining limits across coverage layersWork with actuarial team to support actuarial analyses by preparing clean, accurate datasets for loss projections, reserve studies, and pricing evaluationsTranslate complex insurance and claims data into clear, actionable insights for leadership, risk management, legal, and finance stakeholdersRespond to requests for specific data reports, such as claims data Medicaid and Medicare applicationsDevelop dashboards and visual reports to track loss performance, emerging risks, and program effectivenessIdentify opportunities to improve reporting efficiency, automation, and data accessibilityUse data to support strategic risk mitigation initiatives and loss prevention effortsAssist in developing key performance indicators (KPIs) and metrics for captive operationsSupport internal and external audits by providing accurate, timely, and well-documented dataSupport system upgrades, data migrations, and enhancements related to reporting and analytics; for the claims management system, currently RLDatixReinsurance & External Carrier Reporting:Work with VP, Insurance, captive manager, and insurance broker to track reinsured losses, recoverables, ceded premiums, and reinsurer participation by layerSupport reconciliation of reinsurance payments and recoverables with finance and accounting teamsRespond to reinsurer data requests, audits, and ad hoc reporting needsRegulatory & Statutory Reporting:Manage and support MMSEA (Medicare Secondary Payer) Section 111 reporting, including:a. Data extraction and validationb. Timely and accurate submissions to CMSc. Resolution of CMS errors, rejects, and compliance issuesSupport National Practitioner Data Bank (NPDB) reporting by ensuring data accuracy, completeness, and compliance with reporting thresholds and timelinesAdditional Duties as AssignedTravel: Less than 10% of the time may be requiredWork Type: Hybrid employee - splits time between working remotely and working in the officeMINIMUM REQUIRED QUALIFICATIONS:
Education: Bachelor's degree in a business-related fieldExperience: Minimum five years relevant experienceKnowledge, Skills & Abilities
Knowledge of legal and insurance claims handling principlesBasic accounting skills, ability to navigate various data systems and strong data skillsProficiency with data analysis tools, SQL, BI software (e.g., Tableau, Power BI), and statistical techniquesPresentation skillsJOIN OUR TEAM TODAY! Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive academic health system in Georgia and the first and only in Georgia with a Magnet® designated ambulatory practice. We are made up of 11 hospitals-4 Magnet® designated, the Emory Clinic, and more than 425 provider locations. The Emory Healthcare Network, established in 2011, is the largest clinically integrated network in Georgia, with more than 3,450 physicians concentrating in 70 different subspecialties.
Additional DetailsEmory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.
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