Claims Manager

1 month ago


Miami, United States PayerFusion Full time
Job DescriptionJob Description

Claims Manager

We are looking for a Claims Manager that supervises and manages day-to-day claims operations, including claims evaluation, adjudication and customer service in accordance with agreed quality and production standards. Process claims in a timely manner and complies with industry fair claims practices and applicable state regulations concerning the processing of claims. Sets goals, while being accountable for the results. Manages staff of claims professionals, includes claims examiners, including the regular and timely evaluation of their performance. Maintains good, professional working relationship with superiors, peers, subordinates and other department managers and personnel.

About Us:

We are a service-based company and as a licensed third-party administrator, we are seeking only top talent and experienced personnel in order to meet and exceed our client's expectations. We’re an innovative company creating a unique experience for healthcare professionals. While many industry-wide solutions exist, nothing comes close to our ground-breaking approach.

Duties & Responsibility:

  • Supervise the claims departments to ensure proper workflow is conducted. Monitor timelines and constantly communicate via e-mail with clients to follow up on claims handling.
  • Oversee Claims Examiner Department Responsible for searching the various networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from PayerFusion cost containment efforts. Meets deadlines promised to clients for claims processing.
  • Review and perform quality assessments of work being released to clients to ensure claims processing errors are kept at a minimum. Identify claims that should be audited by the Medical Team when the total charges exceed the pre-established PayerFusion criteria.
  • Coordinate and liaise with other departmental Supervisors as needed to ensure the operational process is followed. Identifies claims where little or no discount is available so that PayerFusion may attempt negotiations on these claims.
  • Implement new procedures for new line of business. Train and cross-train all staff member with the Claims Handling Process and miscellaneous.
  • Review & perform periodic quality assessments of work being released to the clients. Prepare reports as required.
  • Provide clients with daily, weekly and or monthly updates on claims.
  • Train new staff, also cross train existing staff
  • Keep staff current about company, department and organizational issues, in addition to claims eligibility issues or procedures. This will be done via regular departmental meetings, one-on one communications and distribution of written directives.
  • Advise management of any issues raised by staff and suggest actions that will improve processing or resolve the issues. Notify management on eligibility issues.


Knowledge of medical claims coding, different medical specialties and medical services billed for payment by providers to insurance companies is a must.

Bonus Points:

  • PayerFusion provides competitive compensation. Base compensation commences with experience, and knowledge of the claims administration industry.

Benefits

  • Excellent health and dental insurance coverage
  • Free vision, life and hospital gap insurance
  • 12 paid holidays
  • Paid Time Off
  • 401K with company match up to 4%
  • Salary range is commensurate with the experience of the candidate.



  • Claims Manager

    2 weeks ago


    Miami, United States Staffing Now Full time

    Claims Manager Miami, FL  SNI Companies is seeking an experienced Claims Manager to oversee daily operations in our claims department, ensuring compliance with quality and productivity standardsThis role involves managing a small team, overseeing claim assessments, adjudications, and customer support, while adhering to industry practices and state...


  • Miami, Florida, United States King's Insurance Staffing Full time

    Position Overview:King's Insurance Staffing is looking for a dedicated Workers' Compensation Claims Supervisor to lead our claims team in the Northeast Region. This role involves supervising a group of five Claims Examiners who manage both lost time and medical-only claims from initiation to resolution. The supervisor will be tasked with allocating claims to...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Job SummaryCAREERXCHANGE, Inc. is seeking a highly skilled Claims Management Specialist to join our team of professionals. As a Claims Management Specialist, you will play a critical role in managing and resolving a variety of general liability claims, with a particular emphasis on cases involving medical malpractice and other complex scenarios.Key...


  • Miami, United States Alivi Full time

    Job Title: Revenue Cycle SpecialistWelcome to Alivi's job listing. As a Revenue Cycle Specialist, you will be instrumental in facilitating the efficient processing and resolution of outstanding claims within specified timeframes. Below are the key details of the position:Overview:The main focus of this role is to assess the factors contributing to unresolved...


  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims Department In addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customersQualified candidates should have experience in a similar role and be able to...


  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims DepartmentIn addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customers Qualified candidates should have experience in a similar role and be able to...


  • Miami, United States EDI Staffing Full time

    Our client has an exciting opportunity for a Claims Manager to lead their Claims DepartmentIn addition to supervising the Claims personnel, the Manager's primary responsibility will be to ensure accuracy and to achieve cost containment on medical claims for the Company's customers Qualified candidates should have experience in a similar role and be able to...


  • Miami Beach, Florida, United States Mount Sinai Medical Center of Florida Full time

    Insurance and Claims Management Specialist Join Mount Sinai Medical Center, a leader in high-quality healthcare. Since its inception, Mount Sinai Medical Center has been dedicated to providing exceptional healthcare services to a diverse community. Our commitment to clinical excellence is reflected in our recruitment and training of top-tier healthcare...


  • Miami, Florida, United States AppleOne Full time

    Job DescriptionWe are currently seeking a Claims Operations Supervisor to lead our claims team. This role is essential for overseeing the daily operations of claims processing, ensuring adherence to industry standards and regulatory compliance.Your leadership will play a pivotal role in fostering professional relationships and achieving operational...


  • Miami, Florida, United States Insight Global Full time

    Job OverviewInsight Global is seeking a Claims Examination Specialist to join our team. This role involves working in a dynamic environment and offers a contract-to-permanent opportunity with competitive compensation and a flexible first shift schedule.Key Qualifications:High school diploma or GED is mandatory.A minimum of 2 years of experience in medical...


  • Miami, Florida, United States EDI Staffing Full time

    Position OverviewEDI Staffing is seeking a skilled Healthcare Claims Supervisor to oversee our Claims Department. This role is pivotal in ensuring precision and cost efficiency in medical claims processing for our clients.Key Responsibilities:Leadership: Direct the claims and repricing teams to maintain optimal workflow.Client Communication: Regularly update...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Liability Claims SpecialistLocation: Florida (Hybrid after 90-Day Orientation)Job Type: Full-TimeCompany Overview:CAREERXCHANGE, Inc. is a premier insurance provider focusing on general liability and medical malpractice claims throughout Florida. Our organization is committed to offering extensive risk management solutions while prioritizing exceptional...

  • Claims Coordinator

    1 month ago


    Miami, United States Del Monte Fresh Produce Company NA Inc Full time

    Job DescriptionJob DescriptionPurpose of Position:This position will work closely with Credit and Collections, Sales Department, Traffic Claims to research open invoices, and to process pending open claims in a timely manner. In this role, will also maintain compliance with company guidelines, and will perform clerical duties as...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Liability Claims SpecialistLocation: Florida (Hybrid after 90-Day Orientation)Job Type: Full-TimeCompany Overview:CAREERXCHANGE, Inc. is a premier insurance organization focusing on general liability and medical malpractice claims throughout Florida. Our commitment lies in providing thorough risk management solutions while ensuring outstanding service to our...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Company OverviewCAREERXCHANGE, Inc. is a prominent insurance organization focusing on general liability and medical malpractice claims. We are in search of a proficient General Liability Adjuster with relevant experience.Job Summary:The General Liability Adjuster plays a crucial role in the investigation, assessment, and resolution of general liability...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    General Liability AdjusterLocation: Florida (Hybrid after 90-Day Orientation)Job Type: Full-TimeCompany Overview:CAREERXCHANGE, Inc. is a prominent insurance organization focused on general liability and medical malpractice claims throughout Florida. Our commitment lies in providing thorough risk management solutions while ensuring exceptional service to our...


  • Miami, Florida, United States AppleOne Full time

    Job DescriptionWe are seeking a skilled Insurance Claims Specialist to join our esteemed team at AppleOne. This role is essential in managing and resolving claims effectively, ensuring that all processes align with industry standards.Key Responsibilities:Accurately receive and document appeals and balance billing within the claims management system, ensuring...

  • Claims Analyst

    1 hour ago


    Miami, Florida, United States Del Monte Fresh Produce Company NA Inc Full time

    Job SummaryDel Monte Fresh Produce Company NA Inc is seeking a highly skilled Claims Analyst to join our team. As a Claims Analyst, you will play a critical role in researching open invoices and processing pending open claims in a timely manner.Key Responsibilities:Review and research deductions on customers to ensure compliance with company policies and...


  • Miami, United States Assurant Full time

    Job SummaryWe are seeking a highly skilled Claims Adjuster to join our team at Assurant. As a Claims Adjuster, you will be responsible for investigating and adjusting claims in accordance with applicable laws and policy provisions.Key ResponsibilitiesInvestigate and adjust claims in a timely and efficient mannerConduct thorough investigations, including...


  • Miami, Florida, United States CAREERXCHANGE, Inc. Full time

    Company OverviewCAREERXCHANGE, Inc. is a prominent insurance organization focusing on general liability and medical malpractice claims. We are in search of a proficient General Liability Adjuster with relevant experience.Job Summary:The General Liability Adjuster plays a crucial role in the investigation, assessment, and resolution of general liability...