Claims Configuration and Audit Manager
Salary
$88,228.17 - $139,814.02 Annually
Location
Minnesota
Job Type
Full-time
Remote Employment
Flexible/Hybrid
Job Number
25HH342PC26
Opening Date
12/02/2025
Closing Date
12/16/2025 11:59 AM Central
Description
Hennepin Health is seeking a Claims Configuration and Audit Manager to join their team. This position will lead their team in accurately documenting claim related benefit configuration requirements supplied to the claims delegated vendor (FACETS claim adjudication system) for configuration. This position will also be responsible for the day-to-day claims-related backend audit activities required to ensure the claim delegated vendor is adjudicating claims according to the Provider and Minnesota Medicaid contracts. The manager of this team will supervise four senior business analysts and one principal business analyst that document both the benefit and provider contract business requirements, complete the necessary business acceptance testing, and complete the monthly and quarterly claims related audits including error correction and reconciliation, in addition to leading projects and participation in DHS related workgroups.
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Location and hours:
This position is hybrid and will be performed both on-site at 525 Portland Avenue, Minneapolis, MN 55415, and remote as job duties require. Work hours will be Monday through Friday from 8 a.m. to 4:30 p.m. While this position is designated as hybrid, based on current requirements hires must reside in or relocate to Minnesota or Wisconsin. New Employee Orientation (NEO) for all new benefit-earning employees is in-person in downtown Minneapolis. Details about NEO will be provided upon hire.
About the position type:
This is a full-time, benefit-earning position. This position is internally classified as an Administrative Manager, Senior. Click here to view the job classification specification.
Note: You must attach a resume as part of your application materials to be considered for this position.
In this position, you will:
· Manage the end-to-end business development of the benefit and provider contract configuration requirements process to ensure the health plan product benefits and provider contracts are implemented timely and accurately in collaboration with the claims delegated vendor.
· Manage the monthly and quarterly claims audit process including error correction, reconciliation, claims recovery; manage the annual claims accuracy audit in coordination with Hennepin County internal audit and the third-party audit firm.
· Develop and document new departmental business policy and procedures and update existing policy and procedures on an annual basis; ensure adherence to the policy procedures.
· Develop collaborative relationships across Hennepin Health (medical administration, finance, provider contracting, and provider data operations) to proactively address existing issues or new changes that impact the service delivery to our members and providers.
· Ensure quality assurance processes are followed and all approvals are obtained before configuration changes are moved into production.
· Manage, monitor, and troubleshoot all details of claim processing audit activities including root cause analysis, error correction and reconciliation processes, claims recovery projects.
· Supervise and manage direct reports including annual performance reviews, probationary reviews, individual development plans, conduct regularly scheduled development sessions, and conduct team meetings.
· Manage work assignments with staff until completion; support and adhere to issue management and change management processes.
Need to have:
· One of the following:
o Bachelor's degree or higher in business administration or other field appropriate to the position and five years of experience in the planning and administration of organizational operations or programs.
o Nine years or more of experience in the planning and administration of organizational operations or programs.
Nice to have:
· At least five years or more of experience managing a team of direct reports.
· Experience:
o Working collaboratively with other departments to influence a change in business process and implement a benefit change.
o In benefit configuration positions such as benefit configuration design, development, or benefit configuration management in a health plan payer environment.
o Identifying patterns within quantitative data, drawing conclusions, and recommending solutions and approaches, skilled with end-to-end issue resolution.
· Knowledge of:
o Claims clinical coding (CES Optum).
o Provider pricing, product, and benefits analysis.
o Health plan claims processing configuration system (e.g., FACETS).
· Ability to:
o Interact effectively with other areas of the organization regarding Claims Transactions.
o Manage multiple assignments while maintaining quality standards and meeting assigned deadlines.
o Use Microsoft Excel and Word at an intermediate or greater level of proficiency.
o Provide excellent oral and written communication, interpersonal skills, and organizational abilities.
If you have any questions, please contact:
Pajoua Chang
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