Claims Department Director

4 days ago

Fremont, California, United States TITAN Insurance Administrators, Inc. Full time
Claims Department Manager Job Description

TITAN Insurance Administrators, Inc. is seeking an experienced Claims Department Manager to lead our dedicated team.

Job Summary:

The Claims Department Manager will oversee day-to-day claims operations, including claims evaluation, adjudication, analysis, auditing, and customer service, in accordance with quality and production standards.

Key Responsibilities:

  1. Manage claims processing, including claims evaluation, adjudication, analysis, and auditing.
  2. Oversee customer service, ensuring timely and accurate communication with providers and participants.
  3. Lead a team of Assistant Managers and Claims department employees, providing guidance and support to ensure performance, HIPAA compliance, and attendance requirements are met.
  4. Develop and implement processes to improve claims processing efficiency and accuracy.
  5. Collaborate with the IT Department to resolve technical issues related to claims processing and implement new processes and systems.
  6. Ensure compliance with company policies, applicable regulations, and industry standards.
  7. Prepare, analyze, and distribute various reports, medical review letters, appeals, and other claims-related information/documentation.

Requirements:

  1. Bachelor's Degree preferred and at least 10 years of experience supervising claims processing, including knowledge and understanding of group benefit plans, plan benefits, eligibility, limitations, exclusions, etc.
  2. Requires experience in on-line claims adjudication and a working knowledge of claims codes and descriptions, medical terminology, PPO provider guidelines, eligibility, limitations, exclusions, case management, and medical review.
  3. Must be familiar with medical terminology, R.V.S., C.P.T., I.C.D.A., Diagnosis Codes (ICD-10), and H.C.P.C.S. codes.
  4. Ability to develop knowledge and understanding of TITAN's and applicable Carrier's computer systems to the extent necessary for on-line claims processing, data entry, and other related responsibilities.
  5. Ability to accurately interpret plan benefits, process claims, re-calculate claims, and perform calculations using multiplication and percentages.
  6. Develop knowledge and understanding of PPO guidelines and procedures, coordination of benefits, Medicare, and supplemental plan benefits.
  7. Proficiency in Microsoft Office (Word, Excel, Outlook) and data processing.
  8. Willingness to embrace change, self-motivation, and proactive leadership.
  9. Demonstrate ability to effectively manage time, apply practical judgment, and adapt to diverse work environments.

Preferred Qualifications:

  • Possess excellent verbal and written communication skills.
  • Possess analytical and critical thinking skills, and ability to understand and follow moderately complex oral and written instructions.
  • Detailed-oriented, leading a team in a fast-paced environment meeting deadlines and completing tasks in a timely manner while maintaining a positive, courteous attitude.
  • Develop a working knowledge of department locations and organization structure.
  • Ability to operate a keyboard, view a video display terminal screen, and documents, ability to use telephone equipment.
  • Ability to lift up to 10 pounds and push or pull up to 20 pounds.

How to Apply:

Please include the job title in the subject line of your email. Resumes must be included as text or attached as a document. Only candidates who meet the required specifications will be contacted. Please email resumes to -

TITAN Insurance Administrators, Inc. is an equal opportunity employer.

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