Claims Department Manager

4 days ago

Fremont, United States TITAN Insurance Administrators, Inc. Full time


Claims Department Manager


A progressive third-party administrator of union health and welfare benefits, TITAN Insurance Administrators Inc. is seeking an experienced Claims Department Manager with a proven track record in Managing a Claims Processing Department to join our dedicated team. This is a highly visible leadership position.


Job Description:


The Claims Department Manager manages day-to-day claims operations, including claims evaluation, adjudication, analysis, auditing, and customer service, in accordance with quality and production standards. Ensures that claims are processed in a timely manner in compliance with company policies and applicable regulations, concerning the processing of claims. Oversees 2 Assistant Managers in managing a staff of 12 Claims department employees for performance, HIPAA Compliance, following company policies and attendance requirements. Oversees preparation, analysis and distribution of various reports, as well as; Medical Review letters, Appeals and other Claims related information/documentation.


This is a full-time, salaried (exempt) position located in Fremont, CA, with a starting salary range of $170,000 to $190,000 per year, plus benefits (fully paid medical, dental, 401(k) (3% profit sharing)). Reporting to the President.


Essential Job Responsibilities:

The essential job responsibilities include, but are not limited to the following:


  1. Responsible for overseeing preparation, analysis and distribution of various reports, medical review letters, appeals and other claims related information or documentation.
  2. Oversee Assistant Department Managers in distributing work to CE’s, maintaining attendance records, notifications of procedural changes, updates, observance of adherence to visible PHI protocols, training and conducting disciplinary actions.
  3. Apply knowledge and understanding of company and applicable carrier’s computer system (currently Anthem Blue Cross) for on-line claims processing, data entry and other related responsibilities.
  4. Accurately interpret plan benefits and lead department in processing claims accordingly.
  5. Must be able to develop knowledge and understanding of PPO guidelines and procedures, coordination of benefits, Medicare, and supplemental plan benefits.
  6. Experience with new process and system implementation. And interfacing with the IT Department resolving technical issues related to Claims Processing, and trouble shoot claims edits in Anthem Blue Cross system.
  7. Maintains professional working relationship with superiors, peers, subordinates and other department managers and personnel.
  8. When performing Customer Service Supervisory responsibilities; (a) must be able to answer questions regarding eligibility and benefits for all Plans, providing concise and accurate information, quoted directly from Plan documents, without giving advice, and (b) must keep accurate records of requests for eligibility and benefits and a written synopsis of each call and on-line documentation.
  9. Communicate with providers and participants by phone, correspondence, email, faxes or in person.
  10. Assist Auditors and Managers, attend training and staff meetings and other duties as assigned.


Requirements:


  1. Bachelor’s Degree preferred and a least 10 years of experience Supervising claims processing, encompassing knowledge and understanding of group benefit plans, how they relate to claims processing; including plan benefits, eligibility, limitations, exclusions, etc.
  2. Requires experience in on-line claims adjudication and a working knowledge of claims codes and descriptions, medical terminology, PPO provider guidelines, eligibility, limitations, exclusions, case management and medical review.
  3. Must be familiar with medical terminology, R.V.S., C.P.T., I.C.D.A., Diagnosis Codes (ICD-10), and H.C.P.C.S. codes.
  4. Ability to develop knowledge and understanding of TITAN's and applicable Carrier’s computer systems (currently Anthem Blue Cross) to the extent necessary for on-line claims processing, data entry and other related responsibilities.
  5. Ability to accurately interpret plan benefits, process claims, re-calculate claims; performing (sometimes complicated) calculations, applying formulas using multiplication and percentages.
  6. Develop knowledge and understanding of PPO guidelines and procedures, coordination of benefits, Medicare and supplemental plan benefits.
  7. Proficiency in Microsoft Office (Word, Excel, Outlook) and data processing.
  8. Willingness to embrace change, is self-motivated and a proactive leader.
  9. Demonstrate ability to effectively manage time, apply practical judgment, and adapt to diverse work environments.
  • Possess excellent verbal and written communication skills.
  • Possess analytical and critical thinking skills, and ability to understand and follow moderately complex oral and

written instructions.

  • Detailed-oriented, leading a team in a fast-paced environment meeting deadlines and completing tasks in a timely manner while maintaining a positive, courteous attitude.
  • Develop a working knowledge of department locations and organization structure.
  • Ability to operate a keyboard, view a video display terminal screen and documents, ability to use telephone

equipment.

  • Ability to lift up to 10 pounds and push or pull up to 20 pounds.


To Apply:


·        Please include the job title in the subject line of your email.

·        Resumes must be included as text or attached as a document.

·        Only candidates who meet the required specifications will be contacted.

·        Please email resumes to rlosee@titan-tpa.com


TITAN Insurance Administrators, Inc. is an equal opportunity employer.

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