Claims Manager

4 weeks ago

Tampa, United States Leading Edge Full time
Job DescriptionJob DescriptionDescription:

Job Summary:
The Claims Manager provides leadership to the team responsible for processing the billing for healthcare services provided to patients. This role will develop and share knowledge of products, benefits, quality requirements and organization procedures. This position ensures claims are allowed or denied based on actual services rendered, legislative requirement and plan agreements. This position will coordinate both internally and externally by providing information and reporting.

Duties and Responsibilities:

  • Direct and lead claims processing function for clients ensuring metrics are met or and exceeded; incorporating positive feedback and reward mechanisms
  • Hire and manage staffing levels to ensure continuous, quality processing
  • Conduct effective resource planning to maximize productivity and turn-around time
  • Follow and maintain knowledge of Federal and State regulations; implement changes regarding claims and billing requirements
  • Develop, revise, and monitor metrics in order to meet division quality, time service and productivity goals
  • Monitor inventory levels and aging of claims and assist with workflow assignments.
  • Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claim
  • Identify and coordinate resources for re-work
  • Analyze and identify trends and provide robust reports

Requirements:

Required Knowledge, Skills, and Abilities:

  • Bachelor’s degree in a field related to managing claims in the healthcare field such as business administration, accounting, finance, or a related field or equivalent experience
  • 4+ years of experience in a supervisory role in a healthcare claims processing role where HIPPAA and HITECH standards are utilized
  • Experience with benefit administration platforms such as Javelina preferred
  • Knowledge of Federal and State codes related to fiscal operations of healthcare services
  • Knowledge of medical terminology and Diagnosis Codes (ICD-9 & ICD-10)
  • Ability to analyze and interpret problems in data collection, billing, and coding. Determine the source of the problem and apply a solution
  • Must be able to calculate and re-calculate claims; performing (sometimes complicated) calculations, applying formulas using multiplication and percentage
  • Solid working knowledge of standard computer applications including MS Word, Excel Outlook and PowerPoint
  • Ability in using a computer which includes expert keyboard and navigation skills and learning new programs
  • Communicate clearly and professionally with internal and external customers
  • Work effectively as part of a team to achieve established outcomes. Understand other’s roles and empower one another to take responsibility to be successful.
  • Demonstrate a collaborative interaction with peers to reach a common goal as well as be a resource to team members and internal/external customers
  • Pay close attention to detail in all aspects of the job
  • Make decisions using available resources and sound judgment
  • Maintain confidentiality and discretion
  • Identify and resolve problems in a timely manner, gather and analyzes information skillfully
  • Teach, coach, and counsel associates by effectively communicating and providing follow-up.
  • Open to other’s ideas and exhibits a willingness to try new things.
  • Demonstrate accuracy and thoroughness; monitor work to ensure quality.
  • Prioritize and plan work activities to use time efficiently.
  • Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
  • Follows instructions, responds to direction, and solicits feedback to improve.
  • Act in such a way to instill trust from management, other associates, as well as customers

Physical Demands: The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.

  • Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
  • Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
  • Occasional: Lift and/or move up to 10 pounds
  • Constant: Regular, predictable attendance is required
  • Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.

Work Environment: The work environment described is representative of what must be met by an employee successfully perform the essential functions of this job.


  • The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.



The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

  • Field Claims Adjuster

    1 month ago

    Tampa, United States EAC Claims Solutions LLC Full time

    At EAC Claims Solutions, we are dedicated to resolving claims with integrity and efficiency. Join us in delivering exceptional service while upholding the highest standards of professionalism and compliance. Explore more about our commitment to innovation and community impact at www.eacclaims.com. Overview: Join...

  • Claims Manager

    2 months ago

    Tampa, United States Slide Full time

    Job DescriptionJob DescriptionSlide is a cutting-edge Tampa based Technology Enabled Insurance company who is disrupting the industry!To revolutionize all facets of property insurance, we need to do things differently. Therefore, certain traits are required of Sliders in order to be successful in our fast-paced environment. Being able to contribute...

  • Claims Operations Manager

    7 days ago

    Tampa, Florida, United States Truist Full time

    Job OverviewKey Responsibilities:Oversee a skilled Claims Team to assess client requirements and formulate strategies for comprehensive claim and service request management across the organization.Supervise the workflow of claims personnel, including Claims Representatives, Claims Consultants, and Claims Account Executives.Address complex or urgent coverage...

  • Claims Management Specialist

    2 weeks ago

    Tampa, Florida, United States CorVel Full time

    Medical Claims Adjuster (Claims Specialist)Job Category: Enterprise Comp (Claims) Requisition Number: MEDIC04030Job OverviewCorVel is in search of a dedicated Medical Claims Adjuster to oversee straightforward medical-only claims and minor lost-time workers' compensation cases under close supervision. This role is crucial in supporting the objectives of the...

  • Claims Management Associate

    4 days ago

    Tampa, Florida, United States KING'S INSURANCE STAFFING LLC Full time

    Job Summary:KING'S INSURANCE STAFFING LLC is seeking a highly motivated and detail-oriented Auto Liability Claims Associate to join their team in Florida. This entry-level position is ideal for individuals looking to start a career in insurance claims management, focusing on assessing and processing liability claims.Key Responsibilities:Assess and process...

  • Manager of Commercial Residential Claims

    2 weeks ago

    Tampa, Florida, United States Slide Full time

    Job OverviewSlide is a pioneering technology-driven insurance firm based in Tampa, revolutionizing the insurance landscape.As we broaden our offerings to include coverage for Condominium and Homeowner Association properties, along with apartments across Florida, we seek a dedicated Commercial Residential Claims Manager. This role is crucial for overseeing...

  • Manager of Commercial Residential Claims

    7 days ago

    Tampa, Florida, United States Slide Full time

    Job OverviewSlide is a pioneering technology-driven insurance firm based in Tampa, revolutionizing the insurance landscape.As we broaden our service offerings to include coverage for Condominium and Homeowner Association properties, as well as apartments in Florida, we are in search of a Commercial Residential Claims Manager. This role is crucial for...

  • Manager of Commercial Residential Claims

    7 days ago

    Tampa, Florida, United States Slide Full time

    Job OverviewSlide is a pioneering technology-driven insurance firm based in Tampa, revolutionizing the insurance landscape.As we broaden our offerings to include coverage for Condominium and Homeowner Association properties, as well as apartments across Florida, we are in search of a Commercial Residential Claims Manager. This role will oversee the initial...

  • Commercial Residential Claims Manager

    3 weeks ago

    Tampa, United States Slide Full time

    Job DescriptionJob DescriptionSlide is a cutting-edge Tampa based Technology Enabled Insurance company who is disrupting the industry!Slide is expanding our product offerings to insuring Condominium and Homeowner Association properties, and apartments in the state of Florida. Commercial property policies provide coverage for the commonly owned association...

  • Manager of Commercial Residential Claims

    2 weeks ago

    Tampa, Florida, United States Slide Full time

    Job OverviewSlide is a pioneering technology-driven insurance firm based in Tampa, reshaping the property insurance landscape.To transform all aspects of property insurance, we seek individuals who can think outside the box. Successful team members, known as Sliders, exhibit traits such as innovative problem-solving, adaptability to change, and a commitment...

  • Healthcare Claims Operations Manager

    2 weeks ago

    Tampa, Florida, United States Leading Edge Full time

    Job OverviewPosition Summary:The Healthcare Claims Operations Manager is responsible for leading a dedicated team that manages the billing processes for healthcare services rendered to patients. This role emphasizes the development and dissemination of knowledge regarding products, benefits, quality standards, and organizational protocols. The manager...

  • Senior Liability Claims Manager

    7 days ago

    Tampa, Florida, United States RLI Insurance Company Full time

    Position: Senior Liability Claims ManagerCompany: RLI Insurance CompanyAbout UsAt RLI Insurance Company, we take pride in our distinctive approach to delivering outstanding service. Our team of committed professionals is dedicated to achieving excellent outcomes while fostering enduring relationships with our clients and partners. Join us in our mission to...

  • Commercial Residential Claims Manager

    3 months ago

    Tampa, United States Slide Full time

    Job DescriptionJob DescriptionSlide is a cutting-edge Tampa based Technology Enabled Insurance company who is disrupting the industry!To revolutionize all facets of property insurance, we need to do things differently. Therefore, certain traits are required of Sliders in order to be successful in our fast-paced environment. Being able to contribute...

  • Claims Manager

    3 months ago

    Tampa, United States Truist Full time

    ESSENTIAL DUTIES AND RESPONSIBILITIES Following is a summary of the essential functions for this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time. 1. Coach experienced Claim Team to identify client needs and develop strategies for dealing with claim and service...

  • Claims Account Executive

    3 days ago

    Tampa, Florida, United States Truist Full time

    Job SummaryWe are seeking a highly skilled Claims Account Executive to join our team at Truist. As a Claims Account Executive, you will be responsible for managing and delivering complex claim and coverage evaluations on all insurance lines, providing value-added claim consulting services to clients, and driving business growth through strategic client...

  • Claims Management Support Agent

    7 days ago

    Tampa, Florida, United States CorVel Corporation Full time

    Position Overview:Assist the claims team in managing workers' compensation cases, ensuring efficient processing and support for various operational tasks.Key Responsibilities:Initiate and establish new claimsManage incoming correspondence and document entries in the claims databaseOversee payment processing and generate standard correspondenceProvide...

  • Claims Supervisor

    2 months ago

    Tampa, United States Safepoint MGA, LLC Full time

    Job DescriptionJob DescriptionAre you an experienced Claims Adjuster and a natural leader with a passion for guiding teams? Join us as a Claims Supervisor and lead our team to success with your exceptional leadership skills!Safepoint Insurance is a Property and Casualty insurance carrier headquartered in Tampa, FL.Job SummaryManages a team of Claims...

  • Director of Claims

    1 month ago

    Tampa, United States Slide Full time

    Job DescriptionJob DescriptionSlide is a cutting-edge Tampa based Technology Enabled Insurance company who is disrupting the industry!To revolutionize all facets of property insurance, we need to do things differently. Therefore, certain traits are required of Sliders in order to be successful in our fast-paced environment. Being able to contribute...

  • Claims Operations Leader

    2 weeks ago

    Tampa, Florida, United States Truist Full time

    Job OverviewKey Responsibilities:Oversee a skilled Claims Team to assess client requirements and formulate strategies for managing claims and service requests across the organization.Supervise the workflow of claims personnel, including Claims Representatives, Claims Consultants, and Claims Account Executives.Address complex or high-priority coverage and...

  • Claims Supervisor

    1 month ago

    Tampa, United States Ultimate Staffing Full time

    Duties and Responsibilities · Effectively manage the performance of the Claims Team by providing daily leadership and support, coaching, feedback, and direction, incorporating positive feedback and reward mechanisms· Monitor inventory levels and aging of claims and queues to assign work daily.Hire and manage staffing levels to ensure continuous, quality...