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Job Type
Full-time
Description
The Claims Manager is responsible for the daily management of the Medical Claims Processing team members. This position demonstrates high levels of expertise in the department’s operations; provides training and staff development; performs administrative duties and support to deliver high levels of service, quality and production. This position should have a comprehensive understanding of the Plan Documents/Guidelines under their scope of responsibility.
Essential Job Duties:
• Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents
• Administrative
o Serve as a liaison between departments, vendors and clients to ensure collaborative progress
Exhibit strong working knowledge of customer business operations
o Demonstrate strategic business acumen in decisions affecting bottom line focus
o Generate and deliver accurate and timely reports
o Assist with troubleshooting for technical issues
• Customer Service
o Serve as a role model in demonstrating core values of customer service
o Encourage continuous learning, personal development and accountability through team members
o Provide timely and thorough responses to internal and external customers
Respond to member and group correspondences regarding plan/guideline or claim questions within 24 hours
o Escalate difficult issues to the appropriate channels
o Assist in the processing and resolution of escalated issues
• Quality Assurance
o Ensure team compliance with service standards
o Follow trends within assigned scope and alert appropriate parties of any trends that fall outside quality parameters
o Develop and execute plans to meet established goals
o Provide continuous feedback to strengthen and optimize quality performance
o Work cross-departmentally to improve or streamline procedures
o Maintain up to date knowledge on industry trends and look for new data sources
o Develop new and improve current internal processes to improve overall quality
• Special projects as assigned
Management Responsibilities:
• Conduct regular performance evaluations of employees and provide ongoing feedback and coaching as necessary
• Address and counsel employees on behavioral or performance problems and implement corrective action as necessary
• Explain and administer company policies required for team members to perform duties successfully
• Distribute and monitor departmental workloads to ensure adequate coverage while meeting quality and service levels
• Oversee new and ongoing training and update training manuals
• Coordinate and actively participate in departmental meetings
Skills/Abilities:
• Excellent verbal and written communication skills with high attention to detail
• Excellent customer service skills
• Strong analytical and problem-solving skills
• Confident decision-making abilities
• Demonstrated ability to work independently, prioritize workloads and manage priorities to meet deadlines
Requirements
Education/Experience:
· College degree or equivalent required
· Degree in Medical Billing and Coding or related field preferred
· Knowledge of medical terminology preferred
· 7 -10 years Claims Examiner experience or equivalent required
· 4 -7 years management experience required
Physical Requirements:
· Indoor office environment with moderate noise
· Intermittent physical effort may include lifting as much as 25 lbs., walking, stopping, kneeling, crouching or crawling may be required
· Frequent sitting, use of a keyboard, reaching with hands and arms, talking and hearing approximately 70% of the time; 30% or less time is spent standing
· Normal vision abilities required including close vision and ability to adjust focus