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Claims Manager

2 months ago

coral gables, United States SNI Companies Full time

Job Title: Claims Manager


Job Overview

We are searching for an experienced Claims Manager to lead our claims department. The ideal candidate will be responsible for managing daily operations, including claims assessment, adjudication, and customer service, ensuring that all processes adhere to industry standards and state regulations. The Claims Manager will also ensure that claims are processed efficiently and that quality standards are consistently met.


About the Organization

We are a forward-thinking service provider, dedicated to offering superior claims management services. As a licensed third-party administrator, our mission is to exceed client expectations by employing top-notch professionals who are committed to excellence. We are at the forefront of innovation in the industry, providing a distinctive experience for healthcare professionals.


Primary Duties

  • Manage the claims department, ensuring efficient and accurate workflow.
  • Monitor deadlines and maintain consistent communication with clients on the status of claims.
  • Lead the Claims Examiner team, ensuring claims are routed through the correct networks to maximize client savings.
  • Perform quality checks on claims to reduce errors and ensure compliance with standards.
  • Identify claims requiring medical team audits based on established criteria.
  • Collaborate with other department heads to ensure cohesive operations.
  • Identify opportunities for negotiation on claims with minimal discounts to enhance client savings.
  • Develop and implement procedures for new lines of business.
  • Train new employees and cross-train existing staff on claims processing protocols.
  • Conduct regular meetings and distribute updates to keep the team informed about company policies, procedures, and eligibility criteria.
  • Address and resolve staff concerns, providing recommendations for process improvements.
  • Regularly update clients on the status of their claims, ensuring transparency and satisfaction.


Required Skills and Experience

  • Comprehensive knowledge of medical claims coding and familiarity with various medical specialties.
  • Proven leadership experience with the ability to manage and motivate a team.
  • Strong organizational, communication, and problem-solving skills.
  • Ability to implement process improvements and drive operational efficiency.
  • Previous experience in claims management or a related field is highly desirable.


Benefits

  • Competitive salary, commensurate with experience and expertise.
  • Comprehensive health and dental insurance packages.
  • Free vision, life, and hospital gap insurance.
  • 12 paid holidays.
  • Generous Paid Time Off (PTO).
  • 401K plan with a company match of up to 4%.