19 Administration jobs in Riegelwood
Claims Administration Director (Remote)
28412 Wilmington, North Carolina
Vaya Health
Posted 3 days ago
Job Viewed
Job Description
LOCATION: Remote - This is a home based, virtual position that operates Monday - Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL. Preference will be given to a North Carolina resident located in/near our catchment area. There may be a need/request for this employee to travel to Vaya's Asheville NC office on rare occasion.
GENERAL STATEMENT OF JOB
The Claims Administration Director is responsible for providing leadership and direction, policy and procedure guidance, monitoring, analysis, reconciliation, resource allocation, and coordination to the Claims Administration and Claims Encounter Management teams. This position is also responsible for overseeing the provider claims adjudication process in the Managed Care Information System (MCIS), encounter reporting to the Department, including Consumer Data Warehouse (CDW) reporting. The Claims Administration Director is responsible for working with the Claims Administration department to ensure claims adjudication quality control activities are monitored and adhered to as required by Vaya Heath (Vaya) policy. Additionally, this position will work closely with Vaya leadership across the organization, including Plan Configuration, Information Technology, Contracting, Network Provider Relations, Regulatory Affairs, and Clinical Support to meet Vaya's strategic plans and objectives. The duties listed within pertain to both the Medicaid Direct and Tailored Plan which requires oversight for behavioral and physical health claims management.
ESSENTIAL JOB FUNCTIONS
The Claims Administration Director responsibilities include (but are not limited to) the following:
Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, Human Services or related field required. Master's degree preferred.
RESIDENCY REQUIREMENT : The person in this position must live in NC, SC, GA, TN, VA, MD, or FL. Preference will be given to a North Carolina resident located in/near our catchment area. There may be a need/request for this employee to travel to Vaya's Asheville NC office on rare occasion.
SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled.
APPLY: Vaya Health accepts online applications in our Career Center, please visit
Vaya Health is an equal opportunity employer.
GENERAL STATEMENT OF JOB
The Claims Administration Director is responsible for providing leadership and direction, policy and procedure guidance, monitoring, analysis, reconciliation, resource allocation, and coordination to the Claims Administration and Claims Encounter Management teams. This position is also responsible for overseeing the provider claims adjudication process in the Managed Care Information System (MCIS), encounter reporting to the Department, including Consumer Data Warehouse (CDW) reporting. The Claims Administration Director is responsible for working with the Claims Administration department to ensure claims adjudication quality control activities are monitored and adhered to as required by Vaya Heath (Vaya) policy. Additionally, this position will work closely with Vaya leadership across the organization, including Plan Configuration, Information Technology, Contracting, Network Provider Relations, Regulatory Affairs, and Clinical Support to meet Vaya's strategic plans and objectives. The duties listed within pertain to both the Medicaid Direct and Tailored Plan which requires oversight for behavioral and physical health claims management.
ESSENTIAL JOB FUNCTIONS
The Claims Administration Director responsibilities include (but are not limited to) the following:
- Management and Supervision
- Internal & External Collaboration and Oversight
- Administrative Duties
- Provides leadership and direction in order to achieve established business goals and objectives.
- Establish team goals, objectives, and operating procedures.
- Provides leadership for the Claims Administration team to ensure that all claims are processed for payment accurately and in a timely manner.
- Identifies and resolves operational issues using well defined/documented processes, expertise, and judgment.
- Ensures the Claims Administration team participates in system testing to ensure continuous operations.
- Monitors departmental processing activities to ensure that Vaya's service, quality, productivity, service level agreements, and goals are achieved.
- Serves as Vaya's expert in the areas of provider billing, provider reimbursement, encounter reconciliation, member and recipient eligibility, and enrollment.
- Collaborates with other Vaya business teams to develop, document, and standardize procedures and workflows to support operational improvement.
- Participate as a Subject Matter Expert (SME) on systems operations, recommend changes for system design, methods, procedures, and workflows which enhance claims operations.
- Reviews, examines, and provides leadership for the processing and handling of unusual or complex claims or eligibility issues.
- Monitors weekly/monthly reports on claims activities; provides management with updates and progress reports.
- Manages the Claims Administration team to ensure adherence to all departmental policies and procedures, HIPAA regulations, and other state and federal requirements.
- Participates in Cross-Functional Teams (CFTs) as assigned.
- Attends State meetings as needed to stay informed of changes in local, State, Federal, and Division requirements.
- Ensure adjudication rules align with contractual and other regulatory requirements.
- Performs other independent duties and projects as assigned.
- Extensive knowledge of claims management, Medicaid, and State funding rules and regulations, third-party payer, and coordination of benefits.
- Knowledge of various health insurers and coordination of benefits preferred.
- Knowledge and understanding of basic medical terminology.
- Knowledge of a capitated managed care environment.
- Knowledge of Tailored or Specialty Plans.
- Ability to influence strategies and results across multiple functional areas accountable for delivering the customer experience.
- Strong focus on the people side of change, including changes in business processes, systems, and technology, job roles, and organization structures.
- Drive adoption to change, higher utilization of and proficiency with the changes that impacts the staff.
- Ability to work independently, and communicate with associates, providers, and public.
- Organization, time management, planning and project management skills, ability to manage multiple priorities to meet deadlines.
- Ability to think both tactically and strategically in addressing issue resolutions.
- Excellent problem-solving and analytical skills.
- Ability to create/analyze reports and utilize data to drive results.
- Team-oriented and able to interact effectively with other staff.
- Proficient in Microsoft products to include Excel and Outlook.
Bachelor's degree in Business Administration, Accounting, Finance, Healthcare, Human Services or related field required. Master's degree preferred.
- 10 years of claims processing experience; supervisory role with increased responsibilities over time.
- Physical health claims experience within a Medicaid managed care environment is preferred.
- Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
- Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
- Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
- Mental concentration is required in all aspects of work.
RESIDENCY REQUIREMENT : The person in this position must live in NC, SC, GA, TN, VA, MD, or FL. Preference will be given to a North Carolina resident located in/near our catchment area. There may be a need/request for this employee to travel to Vaya's Asheville NC office on rare occasion.
SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open Until Filled.
APPLY: Vaya Health accepts online applications in our Career Center, please visit
Vaya Health is an equal opportunity employer.
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Office Manager
28478 Willard, North Carolina
Robert Half
Posted 16 days ago
Job Viewed
Job Description
Description
We are looking for a dedicated Office Manager to oversee and optimize daily operations in our office located near Wilmington, North Carolina. This role is ideal for someone with strong organizational skills, a knack for effective communication, and the ability to manage administrative tasks with precision.
Responsibilities:
- Direct and coordinate office support services to ensure smooth daily operations.
- Supervise purchasing activities, including vendor selection and contract negotiations.
- Manage office administrative staff, providing guidance and support to maintain productivity.
- Develop and enforce office policies and procedures to promote an efficient work environment.
- Handle basic accounting tasks, such as tracking expenses and managing budgets.
- Identify business opportunities and contribute to the company's growth strategy.
- Conduct cold calling efforts to establish new partnerships and expand the client base.
- Collaborate on business development initiatives, including marketing and client relations.
- Ensure compliance with company standards and local regulations in all office activities.
Requirements - Proven experience in office management or a related administrative role.
- Strong communication skills, both written and verbal, to interact effectively with staff and vendors.
- Basic accounting knowledge and familiarity with financial practices.
- Ability to identify and pursue business development opportunities.
- Proficiency in cold calling and client outreach techniques.
- Solid organizational skills and attention to detail.
- Experience in supervising and managing administrative staff.
- Familiarity with office systems, policies, and procedures.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
We are looking for a dedicated Office Manager to oversee and optimize daily operations in our office located near Wilmington, North Carolina. This role is ideal for someone with strong organizational skills, a knack for effective communication, and the ability to manage administrative tasks with precision.
Responsibilities:
- Direct and coordinate office support services to ensure smooth daily operations.
- Supervise purchasing activities, including vendor selection and contract negotiations.
- Manage office administrative staff, providing guidance and support to maintain productivity.
- Develop and enforce office policies and procedures to promote an efficient work environment.
- Handle basic accounting tasks, such as tracking expenses and managing budgets.
- Identify business opportunities and contribute to the company's growth strategy.
- Conduct cold calling efforts to establish new partnerships and expand the client base.
- Collaborate on business development initiatives, including marketing and client relations.
- Ensure compliance with company standards and local regulations in all office activities.
Requirements - Proven experience in office management or a related administrative role.
- Strong communication skills, both written and verbal, to interact effectively with staff and vendors.
- Basic accounting knowledge and familiarity with financial practices.
- Ability to identify and pursue business development opportunities.
- Proficiency in cold calling and client outreach techniques.
- Solid organizational skills and attention to detail.
- Experience in supervising and managing administrative staff.
- Familiarity with office systems, policies, and procedures.
Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.
Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app ( and get 1-tap apply, notifications of AI-matched jobs, and much more.
All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.
© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking "Apply Now," you're agreeing to Robert Half's Terms of Use ( .
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