Claims Payment Controller

Job Summary

A company is looking for a Claims Payment Controller to ensure accurate and timely payments within their claims platform.

Key Responsibilities

• Oversee payment activities including Fee-for-Service and Capitation payments
• Collaborate with the Finance department to reconcile payments and bank transfers
• Serve as a liaison between the organization and its provider community, addressing payment concerns

Required Qualifications

• 5-8 years of claims processing or system setup experience, preferably in managed care
• High School Diploma or GED required; some college preferred
• General knowledge of provider contracts, fee schedules, and payment methodologies
• Knowledge of health plan benefit interpretation and setup
• Familiarity with current compliance legislation