Claims and Value Care Finance Manager

Health Partners 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.

• 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

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

(Includes duties that represent 10% or more of the role’s time and focus)

• (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
• (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.
• (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
• (15%) – Administer Health Partners 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.
• (15%) – Lead daily operations of Claims/Value‑based Care Finance support team.

  • Manage team to provide work direction, training, cross‑training, development and support.

• (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.