Medical Claims Processing Division Director
2 weeks ago
Job Summary:
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.
Key Responsibilities:
- Oversee claims processing operations, ensuring accuracy and compliance with company policies and regulations.
- Manage team performance, training, and disciplinary actions to ensure high-quality standards and timely claims processing.
- Interpret plan benefits and guide the department in processing claims, ensuring accuracy and compliance.
- Collaborate with IT to resolve system issues and implement process improvements.
- Lead the preparation and distribution of reports, appeals, and medical review letters.
- Provide expert customer service, resolving complex claims issues and communicating with providers and plan participants.
Requirements:
- Bachelor's 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.
- Ability to adapt to change and thrive in a fast-paced environment.
- 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.
What We Offer:
Comprehensive benefits include fully paid medical, dental, and 401(k) with 3% profit sharing. A competitive salary range of $180,000 to $200,000 per year and a Monday through Friday schedule.
Why Join Us:
Cornerstone Staffing Solutions, Inc. is a progressive company seeking a dedicated and experienced Claims Division Manager to lead our team. If you are a motivated and results-driven professional with a passion for claims processing, we encourage you to apply for this exciting opportunity.
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