Job Information
Emory Healthcare/Emory University Claim Data Process Manager in Atlanta, Georgia
Overview
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 more
Work 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)
Tracks and creates monthly loss runs that track all payment and reserve-related movement for third party liability matters insured under Emory’s Liability Program
Processes and monitors Emory Medical Professional, General Liability, and Network Security & Privacy indemnity and expense payments
Works with CCIC manager and actuary to perform monthly reconciliation of liability loss run, insurance program accounting and performance
This position is also responsible for developing claims data analytics, providingdata and trends to clinical and other leadership for purposes of quality and patient safety improvements.
The Claim Data Process Manager will collect data, perform statistical analysis, create dashboards/ reports and collaborate with teams including Claims, Risk, Patient Safety, Quality, and Clinical operating units.
The 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 costs.
Management of Financial processes
Manage time-sensitive monthly financial data processes, including inputting initial reserves and reserve changes as determined by Emory’s claims team, case settlements, legal and related vendor invoices, monthly accounting reconciliation and balancing, and fiscal year end closing
Responsible for running and balancing the monthly loss runs with captive manager and actuary
Data Analysis & Reporting
Collect, validate, normalize, and analyze medical professional and general liability claim data
Develop, maintain, and run standard and ad hoc reports, including but not limited to monthly loss runs, transaction reports, and trend and severity analyses
Track and keep current annual liability insurance tower erosion and limit exhaustion reports to track aggregate losses, paid/incurred amounts, and remaining limits across coverage layers
Work with actuarial team to support actuarial analyses by preparing clean, accurate datasets for loss projections, reserve studies, and pricing evaluations
Translate complex insurance and claims data into clear, actionable insights for leadership, risk management, legal, and finance stakeholders
Respond to requests for specific data reports, such as claims data Medicaid and Medicare applications
Develop dashboards and visual reports to track loss performance, emerging risks, and program effectiveness
Identify opportunities to improve reporting efficiency, automation, and data accessibility
Assist in developing key performance indicators (KPIs) and metrics for insurance program
Support internal and external audits by providing accurate, timely, and well-documented data
Support system upgrades, data migrations, and enhancements related to reporting and analytics; for the claims management system, currently RLDatix
Reinsurance & External Carrier Reporting
Work with VP, Insurance, captive manager, and insurance broker to track reinsured losses, recoverables, ceded premiums, and reinsurer participation by layer
Support reconciliation of reinsurance payments and recoverables with finance and accounting teams
Respond to reinsurer data requests, audits, and ad hoc reporting needs
Regulatory & Statutory Reporting
Manage and support MMSEA (Medicare Secondary Payer) Section 111 reporting, including:
Data extraction and validation
Timely and accurate submissions to CMS
Resolution of CMS errors, rejects, and compliance issues
Support National Practitioner Data Bank (NPDB) reporting by ensuring data accuracy, completeness, and compliance with reporting thresholds and timelines
MINIMUM QUALIFICATIONS:
Bachelor's degree in a business-related field
Minimum five (5) years relevant experience
Knowledge of legal and insurance claims handling principles
Basic accounting skills, ability to navigate various data systems and strong data skills
Proficiency with data analysis tools, SQL, BI software (e.g., Tableau, Power BI), and statistical techniques
Presentation skills
JOIN 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 Details
Emory 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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Division Emory Healthcare Inc.
Campus Location Atlanta, GA, 30345
Campus Location US-GA-Atlanta
Department EHI Office of Insurance Srvc
Job Type Regular Full-Time
Job Number 160162
Job Category Business Operations
Schedule 8a-4:30p
Standard Hours 40 Hours
Hourly Minimum USD $50.18/Hr.
Hourly Midpoint USD $61.14/Hr.
Emory Healthcare is an Equal Employment Opportunity employer committed to providing equal opportunity in all of its employment practices and decisions. Emory Healthcare prohibits discrimination, harassment, and retaliation in employment based on race, color, religion, national origin, sex, sexual orientation, gender identity or expression, pregnancy, age (40 and over), disability, citizenship, genetic information, service in the uniformed services, veteran status or any other classification protected by applicable federal, state, or local law.