Claims Manager

4 weeks ago

Austin, Texas, United States CROWN ADMINISTRATORS Full time
Job Title: Claims Manager

CROWN ADMINISTRATORS is seeking a highly skilled Claims Manager to join our dynamic team. As a Claims Manager, you will play a crucial role in managing our Medical Needs environment, optimizing its performance, and driving continuous improvements to support our business goals and enhance our service delivery.

Key Responsibilities:

  • Manage a team of processors, auditors, and support staff.
  • Enhance Medical Claims processes and procedures through automation and system functionality improvements.
  • Ensure that Claims processing is issued promptly and accurately so client SLA can be achieved.
  • Partner with various department leaders to pursue opportunities for cost savings as it relates to claims.
  • Create and maintain comprehensive Key Performance Indicator (KPI) reports in collaboration with the Senior Leadership Team.
  • Address and document performance issues; perform yearly performance evaluations.
  • Consistently host individual and team meetings with the team members.
  • Approving and disallowing claims within authorization limits.
  • Assisting with difficult or complex claims and research/respond to escalated issues.
  • Provide full-time support as a resource for claims and appeals to internal departments.
  • Interview, hire, and train staff as needed.
  • Manage and handle all claims per the client's guidelines and management requests.
  • Conduct audits to ensure the accurate processing of medical claims, and plan implementation.
  • Manage timesheets, employee schedules, and time-off requests.
  • Perform client-requested claim adjustments; provide clear and concise written responses to each client inquiry within specified time frames.

Requirements:

  • Strong critical thinking and problem-solving skills.
  • Self-motivated and goal-oriented with a positive attitude.
  • Ability to resolve escalated issues efficiently and effectively.
  • Customer-focused mindset with a commitment to excellence.
  • Excellent written, verbal, and interpersonal communication skills.
  • Proficiency in working both independently and collaboratively within a team environment.
  • Solid time management skills.
  • Strong leadership and coaching abilities.
  • Ability to multitask and successfully operate in a fast-paced, team environment.
  • Must adapt well to change and successfully set and adjust priorities as needed.

Education/Experience:

  • Degree in Business Administration, Healthcare Management, or relevant experience preferred.
  • Minimum of 1 year of experience in claims management.
  • Minimum of 1 year in a leadership role, preferably within the healthcare industry.
  • Familiarity with healthcare industry regulations and compliance standards.

What We Offer:

  • Competitive salary and benefits package.
  • Dynamic and innovative work environment.
  • Opportunities for professional growth and development.
  • Remote work flexibility.

Equal Opportunity Statement:

CROWN ADMINISTRATORS is deeply committed to building a workplace and global community where inclusion is not only valued but prioritized. We are proud to be an equal opportunity employer, seeking to create a welcoming and diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, family status, marital status, sexual orientation, national origin, genetics, neurodiversity, disability, age, or veteran status, or any other non-merit based or legally protected grounds. We are committed to providing reasonable accommodation to qualified individuals with disabilities in the employment application process.

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