Medical Claims Processing Division Director

2 weeks ago


Reston, Virginia, United States Cornerstone Staffing Solutions, Inc. Full time
Claims Division Manager Job Description

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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