Under general supervision of the Claims Director, the Claims Manager will oversee the daily operations and performance of the Claims Department. This position directs staff in achieving the departmental and company goals and ensures claims productivity goals are met.
* Will spend roughly 30% of day processing claims per contract or standard processing guidelines
* Maintains prompt turnaround time on all claims and handle priority claims within 24 hours
* Provides guidance to the Claims team and manages the day-to-day operational activities
* Utilizes analytical thinking skills, leadership ability, and business knowledge to help coordinate and lead a department of associates
* Leads large scale implementation of projects and processes to help solve complex organizational problems
* Effectively plans staff responsibilities and manage activities, utilizing staff resources to meet departmental goals in accordance with established business goals
* Schedules and directs work; addresses complaints and resolve problems; monitors monthly production
* Provides ongoing coaching and feedback to enhance the contributions, competencies, and performance of associates
* Manages team daily attendance and overtime; coordinates time off requests and updates time sheets
* Analyzes and reports claims processing trends on schedule as defined
* Selects, develops, and manages staff to ensure appropriate staffing levels to ensure delivery of timely high-quality service form the claims department
* Processes and resolves service issues to ensure superior service to our clients
* Continually work to improve policy and procedures, efficiency, and customer service for internal and external clients
* Other duties as assigned
* Minimum five (5) years management experience in medical claims field
* Bachelor's degree in Accounting/Finance/Business or related field
* Ability to manage effectively in a fast-paced, results-oriented environment
* Experience with managing quality metrics and monitor feedback
* Excellent verbal and written communication skills Desired Qualifications:
* ICD 10 Certification. * Progressive claims experience over 5 years.
* More than 5 years management experience.
* Project management experience.
* Medical, Medicaid and/or government health plan experience.
* Health insurance experience is preferred.
* Regulatory experience.