MediGold Claims Operations Manager

6 days ago

Columbus, Ohio, United States Trinity Health Full time
About the Job

The Claims Operations Manager plays a critical role in ensuring the smooth operation of MediGold's claims review and processing functions. This position is responsible for managing staff relations, developing departmental goals, and overseeing scheduling, recruitment, and payroll.

Key Responsibilities
  • Assist in developing departmental goals, standards, and objectives that align with the organization's strategic plan and vision.
  • Manage staff relations, including performance management, staff satisfaction, and conflict resolution.
  • Oversee scheduling, recruitment, payroll, and student engagements.
  • Monitor departmental budgets, regulatory compliance, departmental contracts, and vendor relations.
  • Support special projects and business analysis as requested.
  • Serve as the main point of contact and subject matter expert for internal and external auditors.
  • Conduct audits, monitor daily performance, and provide feedback to colleagues and supervisor.
  • Take a proactive approach to resolving issues and presenting potential solutions to upper management.
  • Serve as primary trainer for the Claims department through developing and directing ongoing training programs.
  • Attend educational meetings and programs to maintain and expand knowledge regarding Medicare Advantage and related job responsibilities.
Requirements
  • Bachelor's Degree or equivalent combination of education and experience.
  • CPC or equivalent certification preferred.
  • 7 or more years of relevant work experience, including experience in leadership roles.
  • Knowledge of Medicare and Medicare Advantage.
  • Ability to critically think and diffuse potential problematic situations.
  • Strong personal presence characterized by honesty and integrity.
  • Demonstrated ability to understand and meet all technical, educational, and operational needs of a Service Center.
  • Experience developing, executing, measuring, and monitoring continuous service performance improvement initiatives to targeted outcomes.
  • Proficiency with Microsoft Office automation software and knowledge of the claims platform and ancillary applications.
  • Ability to work independently with high-level judgment and discretion.
  • High tolerance for ambiguity and change while providing leadership to department staff to adapt effectively to meet changing environments.
About Trinity Health

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. We integrate diversity, equity, and inclusion in all that we do, recognizing that our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves, providing the most accessible and equitable care for those we serve.

We are an equal opportunity employer and welcome applications from diverse candidates. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or any other status protected by law.

  • Claims Operations Associate

    4 weeks ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled Claims Management Specialist to join our team. As an OSS Coordinator - Claims Support, you will play a critical role in supporting and maintaining the claims management system for our local office or multiple office locations.Key ResponsibilitiesComplete examiner update reports, claim adjustments, provider...

  • Claims Management Specialist

    3 weeks ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled Claims Management Specialist to support and maintain the claims management system for a local office or multiple office locations. As a key member of our team, you will ensure security access meets established policies within assigned groups.Key ResponsibilitiesComplete examiner update reports, claim...

  • Claims Management Specialist

    1 week ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled OSS Coordinator to support and maintain the claims management system for a local office or multiple office locations. As a key member of our team, you will ensure security access meets established policies within assigned groups.Key ResponsibilitiesComplete examiner update reports, claim adjustments,...

  • Claims Management Specialist

    4 weeks ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a highly skilled Claims Management Specialist to join our team. As an OSS Coordinator, you will play a critical role in supporting the claims management system for our local office or multiple office locations.Key ResponsibilitiesComplete examiner update reports, claim adjustments, provider requests, and operational expense...

  • Claims Associate

    3 weeks ago

    Columbus, Ohio, United States Nationwide Insurance and Financial Services Full time

    {"title": "Personal Lines Claims Intern", "description": "About the RoleNationwide Insurance and Financial Services is seeking a highly motivated and detail-oriented individual to join our Personal Lines Claims team as a Personal Lines Claims Intern. As a key member of our team, you will have the opportunity to gain hands-on experience in the claims process...

  • Claims Associate

    3 weeks ago

    Columbus, Ohio, United States Nationwide Insurance and Financial Services Full time

    {"h1": "Personal Lines Claims Intern", "p": "At Nationwide Insurance and Financial Services, we're looking for a talented and motivated individual to join our Personal Lines Claims team as a Personal Lines Claims Intern. As a key member of our team, you'll have the opportunity to learn and grow with us, developing your skills and expertise in claims...

  • Claims Representative

    6 days ago

    Columbus, Ohio, United States Elevance Health Full time

    Job Title: Claims Representative IWe are seeking a highly motivated and detail-oriented Claims Representative I to join our team at Elevance Health. As a Claims Representative, you will play a critical role in ensuring that our members receive the benefits they deserve.Key Responsibilities:Process and analyze claims forms for payment, ensuring all necessary...

  • Claims Analyst

    6 days ago

    Columbus, Ohio, United States Gainwell Technologies LLC Full time

    Job SummaryWe are seeking a skilled Claims Analyst to join our team at Gainwell Technologies LLC. As a Claims Analyst, you will play a critical role in analyzing pre-payment pharmacy claims data, systems, and documents to identify potential claim overpayments and ensure claims are paid accurately.Key ResponsibilitiesAnalyze pharmacy claims pre-payment data...

  • WC Claims Support Specialist

    1 month ago

    Columbus, Ohio, United States Ohio Department of Developmental Disabilities Full time

    Position OverviewThe role of the WC Claims Support Specialist involves assisting in the management and examination of workers' compensation claims. This position is crucial in ensuring that claims are processed efficiently and accurately.Key ResponsibilitiesConduct thorough analysis of claims to determine eligibility and compliance with...

  • Claims Analyst

    6 hours ago

    Columbus, Ohio, United States Gainwell Technologies LLC Full time

    Job SummaryWe are seeking a skilled Claims Analyst to join our team at Gainwell Technologies LLC. As a Claims Analyst, you will play a critical role in analyzing pre-payment pharmacy claims data, systems, and documents to identify potential claim overpayments and ensure claims are paid accurately.Key ResponsibilitiesAnalyze pharmacy claims pre-payment data...

  • WC Claims Support Specialist

    4 weeks ago

    Columbus, Ohio, United States Ohio Department of Developmental Disabilities Full time

    Position OverviewThe role of the WC Claims Support Specialist involves providing essential assistance in the management of workers' compensation claims. This position is critical in ensuring that claims are processed efficiently and accurately.Key ResponsibilitiesAssist in the examination and evaluation of claims.Collaborate with team members to ensure...

  • Claims Representative

    7 days ago

    Columbus, Ohio, United States Elevance Health Full time

    Job Title: Claims Representative IWe are seeking a highly motivated and detail-oriented Claims Representative I to join our team at Elevance Health. As a Claims Representative, you will play a critical role in ensuring that our members receive the benefits they deserve.Key Responsibilities:Process and analyze claims forms for payment, ensuring all necessary...

  • Claims Adjuster

    3 weeks ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a skilled Claims Representative to join our team. As a Claims Representative, you will play a critical role in analyzing and processing low to mid-level auto and transportation claims.Key ResponsibilitiesAnalyze and process auto property damage and lower-level injury claims, assessing damage, making payments, and ensuring...

  • National Claims Supervisor

    6 days ago

    Columbus, Ohio, United States CorVel Corporation Full time

    Job Title: National Claims SupervisorThe National Claims Supervisor is a key role within the CorVel Corporation, responsible for overseeing a team of claims professionals to ensure the highest level of quality, productivity, and customer service. This position requires strong leadership and management skills, as well as a deep understanding of workers'...

  • Claims Specialist

    3 weeks ago

    Columbus, Ohio, United States Sedgwick Full time

    About the RoleSedgwick is seeking a skilled Claims Representative to join our team. As a Claims Representative, you will play a critical role in analyzing and processing low to mid-level auto and transportation claims.Key ResponsibilitiesProcess auto property damage and lower-level injury claims, assessing damage, making payments, and ensuring claim files...

  • Daily Property Claims Adjuster

    4 weeks ago

    Columbus, Ohio, United States Alacrity Solutions Full time

    Job Description**About Alacrity Solutions**Alacrity Solutions is a leading provider of end-to-end insurance claims services, delivering streamlined solutions for property, auto, heavy equipment, and casualty claims management. Our comprehensive services include staffing capabilities, temporary housing, managed repair networks, and subrogation services,...

  • Liability Claims Professional

    3 weeks ago

    Columbus, Ohio, United States Gallagher Full time

    About the RoleWe are seeking a highly skilled Claims Resolution Specialist to join our team at Gallagher. As a Claims Resolution Specialist, you will play a critical role in analyzing and resolving liability claims, ensuring that our clients receive the best possible outcomes.Key ResponsibilitiesAnalyze claims data to identify potential risks and develop...

  • Excess Loss Claims Specialist

    1 week ago

    Columbus, Ohio, United States Elevance Health Full time

    About the RoleWe are seeking a highly skilled Excess Loss Specialist to join our team at Elevance Health. As a key member of our organization, you will play a critical role in reviewing claims and interpreting contracts.Key ResponsibilitiesWork independently to review claims and interpret contractsManage a large volume of files and interact with multiple...

  • Excess Loss Claims Specialist

    2 weeks ago

    Columbus, Ohio, United States Elevance Health Full time

    Job Title: Excess Loss SpecialistWe are seeking a highly skilled Excess Loss Specialist to join our team at Elevance Health. As an Excess Loss Specialist, you will play a critical role in reviewing claims and interpreting contracts, working with complex concepts of excess loss, managing a large volume of files, and interacting with multiple reinsurance...

  • Healthcare Claims Auditor

    4 weeks ago

    Columbus, Ohio, United States inAssist Full time

    Job OverviewPosition: Healthcare Claims Auditor / Advocate II inAssist is a prominent provider of Healthcare Management Solutions, leveraging our Medical Claims Auditors / Advocates, advanced analytics, and customized technology solutions. Our dedication to our clients drives us to deliver outstanding service. The Healthcare Claims Auditor / Advocate II is...