Medical Claims Manager

3 weeks ago

Cypress, United States SCUFCW Trust Fund Full time

Job DescriptionJob Description

The Need:

We are seeking a Medical Claims Manager to join our growing team. In this role, you will be responsible for providing leadership, oversight and expertise to the Claims team. In addition, this position is accountable for overseeing the administration of medical, dental, and vision claims to include the adjudication process and responding to inquiries. The position may provide oversight to one or more of the following teams: Claims Production, Claims Customer Service, and Claims Audit, Adjustments and Recovery.

ESSENTIAL DUTIES AND RESPONSIBILITIES

include the following. Other duties may be assigned.

1. Accountable for ensuring team goals and key performance indicators meet or exceed the standards established for the department.

2. Evaluate business processes and perform high level analysis to leverage opportunities for operational improvements.

3. Ensures timely and proper disposition of claims related work in accordance with the Plan coverage and regulatory requirements.

4. Lead the implementation of standard work to ensure that appropriate controls and compliance is maintained at all times.

5. Manage and supervise daily workflow and preparation of daily, weekly, monthly production and inventory reports to ensure business objectives are maintained.

6. Accountable for managing operational risk.

7. May be accountable for deliverables of a third party or vendor.

8. Hires, coaches, counsels and evaluates performance of direct reports.

9. Maintain current department knowledge of plan documents, summaries of plan provisions and other plan materials.

EDUCATION and/or EXPERIENCE :

· High School diploma or GED required.

· Associate’s or Bachelor’s degree in a related field or a combination of education and experience highly preferred.

· Minimum 5 years of prior managerial claims experience required.

· Thorough knowledge of applicable laws, regulations and procedures.

· Highly proficient in MS Office. (Excel, Word and Outlook)

· Ability to analyze and interpret data.

· Solid understanding of CPT, HCPC, ICD9/10 coding, medical and claims terminology.

· Comprehensive knowledge of the Fund's and the Health Care Claims Departments' policies, procedures, and business rules.

Company DescriptionThe Southern California United Food & Commercial Workers Unions and Joint Benefit Trust Funds (UFCW) is located in Cypress, California. We serve more than 100,000 collective bargaining employees that serve in the grocery stores throughout Southern California. UFCW provides medical, dental, vision and pension benefits for the grocery workers. We take pride in supporting the valuable grocery store employees as they serve customers throughout the region.Company DescriptionThe Southern California United Food & Commercial Workers Unions and Joint Benefit Trust Funds (UFCW) is located in Cypress, California. We serve more than 100,000 collective bargaining employees that serve in the grocery stores throughout Southern California. UFCW provides medical, dental, vision and pension benefits for the grocery workers. We take pride in supporting the valuable grocery store employees as they serve customers throughout the region.

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