Job Description
Job Overview:
Position Summary...
About this team...We are in the business of people. At Walmart Claims Services, we have a passion for helping our associates and customers get back to their everyday lives after an accident or injury. Making a difference and impacting the lives of others, through the stressful time of a claim is our expertise. Our value goes beyond competitive wages, health benefits and stock ownership. Our flexible work environment, company-wide collaboration, and a fresh take on industry best practices means that Walmart Claims Services is more than just a job, it is a career destination.
What you'll do...
What you'll do...
As the Manager – Medical Claims Programs you will be responsible for helping to design and deliver a comprehensive vendor management program that supports our nationwide claims business. You will be part of a team leading our vendor selection process, designing and executing a new strategy for RFPs and managing legacy programs; and working with our vendors and partners to negotiate contracts on behalf of Walmart Claims Services to include ongoing program management.
You'll make an impact by...
• Developing strong relationships with both our internal contracting and procurement partners as well as external vendors.
• Possessing strong verbal and written communication skills.
• Possessing a great deal of energy, optimism and a positive attitude.
• A holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping strategy.
• Serve as the day-to-day contact for assigned vendors.
• Monitor vendor performance against service level agreements (SLAs), ensuring compliance with contractual obligations and quality standards.
• Conduct regular performance reviews and provide feedback to provide continuous improvement.
• Overseeing the end-to-end medical bill review process to ensure timely and accurate processing.
• Overseeing pharmacy benefit management program with related service provider.
• In addition to primary programs, the role will include oversight of other medical ancillary services programs as assigned. Examples include, but are not limited to: physical therapy, durable medical equipment, diagnostic imaging, home health, dental networks, etc.
• Review and approve vendor-recommended adjustments and cost savings.
• Address and resolve discrepancies or escalations in the bill review process.
• Generate and present detailed reports on bill review performance, cost savings and compliance metrics to Walmart leadership as well as other programs as assigned.
• Collaborate with the vendors to develop and track key performance indicators (KPIs).
• Staying updated on legislative changes that may impact the bill review as well as other medical program processes and collaborate with the vendor to implement necessary adjustments.
You’ll sweep us off our feet if you have…
• Demonstrated experience proactively partnering with a business throughout negotiation process.
• Have experience engaging in data analysis, understanding business perspective and needs, supporting administrative function of contracting process, and assisting with training and implementation of new processes.
• Drives execution and implementation of WCS projects and programs by developing timelines; developing communication materials; managing the implementation of WCS projects and programs
• Successfully executed and implemented large-scale projects and programs impacting teams in a highly matrixed organization on time; and developing clear and simple communication and training materials.
• Documented ability to manage multiple program streams at a national level meeting quarterly and annual program OKRs.
Qualifications:
• Claims/Risk Management Industry Acumen
• 3-5 years’ experience working in the claims, healthcare or risk management field.
• Project Management
• 1-3 years’ experience in project management related to program management.
• Ability to form positive working relationships with internal and external stakeholders.
• Working understanding of medical terminology, CPT coding and occupational medical treatment standards.
• Strong analytical and data interpretation skills, with proficiency in Excel and data visualization.
• Experience managing third-party vendors or service providers.
• Knowledge of workers’ compensation laws, regulations and medical billing practices.
• Familiarity with AI-driven bill review processes or tools.
• Experience in large-scale workers’ compensation or healthcare management.
• Insurance industry certifications preferred (Including but not limited to the following: AIC, CPCU, ARM, etc)
The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.
You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.
For information about PTO, see https://one.walmart.com/notices.
Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart.
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.
For information about benefits and eligibility, see One.Walmart.
The annual salary range for this position is $70,000.00-$130,000.00
Additional compensation includes annual or quarterly performance bonuses.
Additional compensation for certain positions may also include:
- Stock
Minimum Qualifications...
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Option 1: Bachelor's degree in business, supply chain, economics, technology, or related field and 2 years' experience in procurement strategy, contract management, analytics, or related field. Option 2: 4 years’ experience in procurement strategy, contract management, analytics, or related field.Preferred Qualifications...
Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Data modelling, data analytics, and data management, Qualified experience in Microsoft Excel