Claims Division Manager

2 months ago

Reston, Virginia, United States Cornerstone Staffing Solutions, Inc. Full time

Competitive Salary Range: $180,000 to $200,000 per year

Standard Business Hours: Monday through Friday Schedule

Comprehensive Benefits: Fully paid medical, dental, and 401(k) with 3% profit sharing.

Cornerstone Staffing Solutions, Inc. is seeking an experienced Claims Division Manager to lead a dedicated team for our progressive client. This leadership role offers the opportunity to oversee critical claims operations and drive performance improvements in a highly visible position.

Position Overview:

As Claims Division Manager, you will lead and supervise a team of 14 claims examiners and will be responsible for maintaining high-quality standards, HIPAA compliance, and timely claims processing. You will supervise and manage claims operations, including evaluation, adjudication, auditing, reports, appeals, and customer service, while ensuring compliance with company policies and regulations.

Key Responsibilities:

  • Oversee claims processing operations, ensuring accuracy and compliance.
  • Conduct thorough investigations and audits to resolve claim discrepancies and ensure accuracy.
  • Manage team performance, training, and disciplinary actions to ensure a high-performing team.
  • Interpret plan benefits and guide the department in processing claims to ensure accurate and timely resolution.
  • Collaborate with IT to resolve system issues and implement process improvements to enhance claims processing efficiency.
  • Lead the preparation and distribution of reports, appeals, and medical review letters to ensure timely and accurate communication.
  • Provide expert customer service, resolving complex claims issues and communicating with providers and plan participants to ensure satisfaction.

Requirements:

  • Bachelor's degree in a related field (preferred), with 10+ years of management experience in claims processing.
  • Strong knowledge of group benefit plans, claims adjudication, medical terminology, and claims codes (ICD-10, CPT, HCPCS).
  • Supervise customer service as an expert regarding eligibility and benefit plans, accurately communicating, documenting, and training.
  • Experience with PPO guidelines, Medicare, and supplemental plan benefits.
  • Proficiency in claims processing systems (Anthem Blue Cross) and Microsoft Office.
  • Excellent leadership, communication, and problem-solving skills to drive performance improvements and ensure compliance.
  • Ability to adapt to change and thrive in a fast-paced environment, with a focus on continuous improvement.
  • Technologically savvy in resolving issues relating to processing, troubleshooting, and editing Anthem Blue Cross systems.
  • Collaboration with IT and cross-functional teams to troubleshoot, implement, and optimize claims systems.

Why Join Our Team:

As a Claims Division Manager at Cornerstone Staffing Solutions, Inc., you will have the opportunity to lead a dedicated team and drive performance improvements in a highly visible position. You will be responsible for overseeing critical claims operations and ensuring compliance with company policies and regulations.

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