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Medical Claims Manager
2 months ago
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 customers
Qualified candidates should have experience in a similar role and be able to execute the Duties and Responsibilities listed below
Duties & Responsibilities:
- Supervise the claims and repricing departments to ensure proper workflow is conducted
- Monitor timelines and constantly communicate with clients to follow up on claims handling.
- Responsible for searching PPO networks and direct contracts database to determine the appropriate network that a claim should be processed through to secure the greatest savings to customers
- 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 criteria.
- Coordinate and liaise with other department Supervisors to ensure the operational process is followed.
- Identifies claims where little or no discount is available so that the Company may negotiation those claims.
- Implement new procedures for new lines of business
- Train and cross-train all staff member with Claims Handling Process.
- Provide clients with daily, weekly and or monthly updates on Claims
- Review all rejected claims from Healthcare
- Prepare Eligibility file for Healthcare
- Collaborate and communicate with other departments on claims issues.
- Train new staff, also cross train existing staff
- 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
