Manager, Claims Operations

POSITION SUMMARY

The Manager, Claims Operations will oversee the Claims Processing department. This position will be responsible for managing a team to ensure that claims are processed accurately, efficiently and in accordance with established policies and procedures. Additionally, the Manager, Claims Operation will develop and implement strategies to improve the claims process and enhance member experience.

ESSENTIAL FUNCTIONS

• Work with Human Resources to interview, select, hire, and onboard an appropriate number of employees
• Coach, mentor, and develop staff, including training/overseeing new employees
• Empower employees to take responsibility for their jobs and goals.  Delegate responsibility and expect accountability and regular feedback
• Lead employees using a performance management and development process that provides an overall context and framework to encourage employee contribution and includes goal setting, feedback, and performance development planning
• Develop and implement strategies that align with the company’s overall goals and objectives.
• Provide comprehensive support for new business across all books of business
• Collaborate with other departments to streamline workflows for better efficiency and accuracy
• Monitor all reports for all books of business to ensure that all claims are handled timely and accurately
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.

• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed
• Actively engage, coach, counsel and provide timely, and constructive performance feedback
• Attend outside audits as needed to ensure accurate reporting
• Attend continuing education classes as required, including but not limited to HIPAA training.
• Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto
• Other duties as assigned

EDUCATION

• Bachelor’s Degree or equivalent work experience required

EXPERIENCE AND SKILLS

• A minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) required
• A minimum of 5 years’ experience at a manager level with successfully demonstrated leadership competencies is required    
• All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology
• Excellent written and verbal communication skills
• Exceptional time management skills and ability to prioritize work

 

 

POSITION COMPENTENCIES

• Accountability 
• Coaching and Feedback 
• Collaboration 
• Customer Focus 
• Decision Making 
• Execution Management 
• People Leadership 

 

 

PHYSICAL DEMANDS

• This is an office environment requiring extended sitting and computer work. 

 

 

WORK ENVIRONMENT

• Remote

 

The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.