Senior Claims Operations Leader
1 week ago
Job Description
We are seeking a Senior Claims Operations Leader to join our team at APWU AFL-CIO HEALTH PLAN. This is an exciting opportunity for a results-driven professional to lead and manage a team of claims analysts, ensuring efficient and effective claims processing.
About the Role
- This position reports directly to the Manager, Claims Department and is responsible for supervising employees in analyzing and adjusting claims, including OIC/COB, SNF, DRG, Travel Claims, Medicare, Tricare, Foreign Currency, Managed Care, PPO, Workers' Compensation, and subrogation.
- The successful candidate will have strong analytical and problem-solving skills, as well as excellent leadership and motivational abilities to effectively manage a team of claims analysts.
Key Responsibilities
- Develop and implement process improvements to enhance claims processing efficiency and accuracy.
- Manage unit resources to meet predetermined objectives, including administering Plan policy, handling employee/labor-relations issues, and ensuring consistent processing policies and guidelines.
- Collaborate with other departments to ensure seamless claims processing and resolution.
- Stay up-to-date with industry developments and best practices in claims management.
Requirements
- AA degree (or commensurate experience) preferred.
- Must have QNXT processing experience and subrogation, Medicare, Medicaid, and OIC/COB experience.
- 5+ years' experience in a supervisory/work leader capacity and extensive claims and claims adjustment knowledge.
- Excellent communication and interpersonal skills are essential for this role.
Salary Range
$70,000 - $90,000 per annum, depending on experience.
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