Virginia Department of Human Resource Management
Claims Manager
Virginia Department of Human Resource Management, Richmond, Virginia, United States, 23214
Claims Manager
Job no:
5087710 Work type:
Full-Time (Salaried) Location:
Richmond (City), Virginia Categories:
Health and Human Services
Title:
Claims Manager
State Role Title:
Prog Admin Manager III
Hiring Range:
$103,342 - $131,234
Pay Band:
6
Agency:
Dept of Med Assistance Svcs
Location:
Dept of Medical Asst Services
Agency Website:
www.dmas.virginia.gov
Recruitment Type:
General Public - G
Job Duties
The Department of Medical Assistance Services (DMAS) is excited to offer a competitive hourly opportunity to serve as a Claims Manager. The selected competitive candidate will provide exceptional delivery of services to the agency's Program Operations Unit.
Job responsibilities will include, but are not limited to:
This position will have direct oversight of the Claims Unit to include complex claims resolution, temporary detention order claims, and oversight of the Call Center and Claims portions of the Fiscal Agent Services (FAS) contract in the Program Operations Division.
This position will also write and monitor information, maintenance and emergency service requests, participate in system testing, and system implementations for the unit.
This position provides individual expertise with internal and external stakeholders throughout the division and agency with respect to the administration of complex claims and billing resolution as needed.
This position provides individual expertise throughout the division and agency with respect to the administration of complex policy and procedural requirements associated with Program Operations.
Provides the Division Director with support on policy and procedural issues and creates studies and analysis as needed.
Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org
The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.
DMAS wants talented individuals who can align their experience with the mission of the agency and its core values - service, collaboration, trust, problem solving and adaptability.
At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.
Minimum Qualifications
Competitive candidates will meet these minimum qualifications:
Considerable operational experience in a healthcare claims environment.
Considerable experience participating in claims system implementations and testing.
Considerable experience in contract management, health care business processes, project management, and policy development.
Considerable experience in planning and implementing large scale/time sensitive operations and projects.
Considerable experience with utilizing software programs.
Knowledge/Experience interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholders.
Additional Considerations
Competitive candidates should meet these additional considerations:
Considerable knowledge of federal and state regulations governing the administration of Medicaid and related programs.
Special Instructions
You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to "Your Application" in your account to check the status of your application for this position.
The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E-Verify Program.
The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth's Department of Human Resource Management Policy 1.61 Teleworking.
This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.
This position requires the submission of a Statement of Economic Interest (financial disclosure).
If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.
Applications and/or resumes should include relevant work history which indicates your qualifications for this position.
The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.
In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155
The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.
Contact Information
Name: DMAS Talent Acquisition
Phone: (804)-225-4407
Email: askhcdtalentacq@dmas.virginia.gov
In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.
Note :
Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.
Advertised:
04 Aug 2025 Eastern Daylight Time Applications close:
18 Aug 2025 Eastern Daylight Time
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Job no:
5087710 Work type:
Full-Time (Salaried) Location:
Richmond (City), Virginia Categories:
Health and Human Services
Title:
Claims Manager
State Role Title:
Prog Admin Manager III
Hiring Range:
$103,342 - $131,234
Pay Band:
6
Agency:
Dept of Med Assistance Svcs
Location:
Dept of Medical Asst Services
Agency Website:
www.dmas.virginia.gov
Recruitment Type:
General Public - G
Job Duties
The Department of Medical Assistance Services (DMAS) is excited to offer a competitive hourly opportunity to serve as a Claims Manager. The selected competitive candidate will provide exceptional delivery of services to the agency's Program Operations Unit.
Job responsibilities will include, but are not limited to:
This position will have direct oversight of the Claims Unit to include complex claims resolution, temporary detention order claims, and oversight of the Call Center and Claims portions of the Fiscal Agent Services (FAS) contract in the Program Operations Division.
This position will also write and monitor information, maintenance and emergency service requests, participate in system testing, and system implementations for the unit.
This position provides individual expertise with internal and external stakeholders throughout the division and agency with respect to the administration of complex claims and billing resolution as needed.
This position provides individual expertise throughout the division and agency with respect to the administration of complex policy and procedural requirements associated with Program Operations.
Provides the Division Director with support on policy and procedural issues and creates studies and analysis as needed.
Located in beautiful Central Virginia, the Richmond area puts you just 2 hours from the Blue Ridge Mountains, Virginia Beach and Washington DC. To learn more about the Richmond, VA area visit: https://www.virginia.org
The Department of Medical Assistance Services (DMAS) is working to improve the health and well-being of Virginians through access to high quality health care coverage.
DMAS wants talented individuals who can align their experience with the mission of the agency and its core values - service, collaboration, trust, problem solving and adaptability.
At the Department of Medical Assistance Services (DMAS) we encourage and promote that you Come as you are | Become who you want to be | That is our promise.
Minimum Qualifications
Competitive candidates will meet these minimum qualifications:
Considerable operational experience in a healthcare claims environment.
Considerable experience participating in claims system implementations and testing.
Considerable experience in contract management, health care business processes, project management, and policy development.
Considerable experience in planning and implementing large scale/time sensitive operations and projects.
Considerable experience with utilizing software programs.
Knowledge/Experience interpretation and application of federal, state laws/regulations.
Experience in meeting deadlines.
Experience with internal/external stakeholders.
Additional Considerations
Competitive candidates should meet these additional considerations:
Considerable knowledge of federal and state regulations governing the administration of Medicaid and related programs.
Special Instructions
You will be provided a confirmation of receipt when your application and/or résumé is submitted successfully. Please refer to "Your Application" in your account to check the status of your application for this position.
The Virginia Department of Medical Assistance Services (DMAS) does not offer employment-based Sponsorship. Selected candidates will have their work authorization completed using the E-Verify Program.
The Department of Medical Assistance Services (DMAS) is an Executive Branch agency that will adhere to all policies and procedures, to include the Commonwealth's Department of Human Resource Management Policy 1.61 Teleworking.
This position requires a fingerprint based Criminal History Background Check, Education Checks if applicable, Work History Verification with references.
This position requires the submission of a Statement of Economic Interest (financial disclosure).
If you wish to apply for a job with the Department of Medical Assistance Services, an application and/or resume for employment must be submitted electronically through this website. Mailed, faxed, emailed, or hand-delivered applications/resumes will not be accepted. Consideration for an interview is based solely on the relevant information presented in the state application and/or resume submitted before the closing date.
Applications and/or resumes should include relevant work history which indicates your qualifications for this position.
The Department of Medical Assistance Services practices fair and equal employment opportunity to all employees and applicants in accordance with applicable laws and regulations. It is our policy to prohibit discrimination on the basis of race, sex, color, national origin, religion, sexual orientation, gender identity, age, veteran status, political affiliation, genetics, or disability in the recruitment, selection, and hiring of its workforce.
In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth's Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly called a Certificate of Disability) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans may also apply via the AHP if they also provide an AHP Letter. To request an AHP Letter, use this link: https://www.dars.virginia.gov/drs/cpid/PWContact.aspx or call DARS at 800-552-5019, or DBVI at 800-622-2155
The Department of Medical Assistance Services is a V3 certified state agency that provides hiring preference to veterans and members of the reserves and/or National Guard in support of executive order 29, (2010). If you are a Veteran or Spouse of a Veteran or Active Military Member, DMAS encourages you to apply and respond accordingly on your state application.
Contact Information
Name: DMAS Talent Acquisition
Phone: (804)-225-4407
Email: askhcdtalentacq@dmas.virginia.gov
In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through the Commonwealth Alternative Hiring Process. To be considered for this opportunity, applicants will need to provide their AHP Letter (formerly COD) provided by the Department for Aging & Rehabilitative Services (DARS), or the Department for the Blind & Vision Impaired (DBVI). Service-Connected Veterans are encouraged to answer Veteran status questions and submit their disability documentation, if applicable, to DARS/DBVI to get their AHP Letter. Requesting an AHP Letter can be found at AHP Letter or by calling DARS at 800-552-5019.
Note :
Applicants who received a Certificate of Disability from DARS or DBVI dated between April 1, 2022- February 29, 2024, can still use that COD as applicable documentation for the Alternative Hiring Process.
Advertised:
04 Aug 2025 Eastern Daylight Time Applications close:
18 Aug 2025 Eastern Daylight Time
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