Claims and Value Based Care Finance Manager

HealthPartners is hiring Claims and Value Based Care Finance Manager. The Manage provider reimbursement and FP&A support of off-system payments, including value-based care (VBC) arrangements. Manage system changes related to non-standard provider reimbursements such as provider VBC arrangements. Responsible for estimating claims IBNR and claims performance reporting as part of month end process.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:
  
  
  
  • Bachelor's degree (Finance, Accounting, or related) with 5+ years of experience or 7+ years of equivalent experience
  
  
• Knowledge, Skills, and Abilities:
• Health Industry Experience
• Leadership experience
• Effective communication skills, written and oral
• High level of business and organization knowledge
• Excellent financial analysis skills
• Strong systems skills and ability to keep up to date with system changes

PREFERRED QUALIFICATIONS:

• Knowledge, Skills, and Abilities:
• Health Plan Insurance experience
• Experience with Claims Forecasting and/or IBNR estimation

ESSENTIAL DUTIES: (Includes duties that represent 10% or more of the role's time and focus)

1. (20%) - Manage the month end review of claims lags and IBNR estimation process along with providing reporting/analysis of claims trends and performance

• Ensure IBNR calculations and process provide most reasonable estimates. Collaborate with Accounting and Actuarial departments review and calibration of estimates.
• Review high-cost claims and stop loss claims and follow up with appropriate areas to ensure we are reserving appropriately.
• Provide reporting and analysis on monthly claims trend performance, identifying key drivers and forecast variances

1. (20%) - Off-system Claims General Ledger and FP&A Support

• Support accounting for off-system claims general ledger accruals and provide month end reporting.
• Provide financial planning and analysis support for budgeting/forecasting and reporting of off-system claims for health plan (e.g. VBC arrangements, non-adjudicate payment processes, provider settlements, non-claim medical expenses, etc.).
• Serve as subject-matter-expert and primary finance lead for ad-hoc analysis/projections for off-system claims and for provider contracting impacts/arrangement.
• Role may present opportunities to provide additional finance oversight/support for Medical/Rx claims forecasting/projections.

1. (20%) - Provide oversight of the financial reporting for value-based care (VBC) arrangements

• Review VBC quarterly results for accuracy, timeliness and ensure appropriate controls are in place.
• Analyze and provide summary of key trends to review with Provider Relations/Network Management team
• Review of accruals and payments for provider value-based arrangements
• Effectively summarize and report on provider settlement information

1. (15%) - Administer HealthPartners Provider Withhold settlement process.

• Ensure annual settlements for providers are completed accurately and all contractual deadlines are met for both provider and health plan groups.
• Oversee process of calculating annual settlements is efficient, and effective controls are in place.

1. (15%) - Lead daily operations of Claims/Value-based Care Finance support team.

* Manage team to provide work direction, training, cross-training, development and support.

1. (10%) - Manage system changes related to provider value-based care (VBC) changes and withhold settlement process

• Understand systems that support provider value-based care payment arrangements
• Work with IT for any changes to provider VBC arrangements and ensure accuracy of changes through reviewing testing.
• Ensure financial reporting systems are efficient, and effective internal controls exist.
• Effectively work with Provider Relations/Network Management in a team approach to bring the settlement process to closure.