Claims Manager

Summary

• Oversees the operation of the Claims Department and ensures the department meets targets with respect to turnaround time, accuracy, and other benchmarks.
• Supervises department employees including hiring, training, coaching, and developing employees; assigning work; and evaluating performance.
• Establishes department policies and procedures including processing guidelines to ensure efficiency, accuracy, and consistency in accordance with Senior Management intent, Federal and State mandates, insurance industry standards, and plan documents.
• Maintains and updates health plans in the claims system.
• Updates the claims system after new edit releases and other updates.
• Generates system reports and oversees the preparation of daily, weekly, monthly, and other productivity reports to monitor claim processing standards and timelines and assist in workflow distribution.
• Keeps current with industry changes and how they affect claims processing.

Qualifications

Required

• High school diploma or GED
• Excellent organizational, analytical, and time management skills
• Strong attention to detail
• Strong decision-making, leadership, presentation, problem-solving, and oral and written communication skills
• Able to consistently meet deadlines
• Effectively present information in one-on-one and small group situations to customers, clients, Senior Management, and other employees of the Company
• Intermediate-level proficiency in Microsoft Word and Excel

Preferred

• College degree in Business Administration, Healthcare Management or related field; five years of experience in claims supervision or management or related experience; or equivalent combination of education and experience
• Proficient in medical terminology, medical billing, and medical coding
• Thorough knowledge of claims administration, regulations, and processing systems

Starting Salary Range: $55,000 - $80,000. Full salary range is broader and depends on experience.