Claims Manager

Responsibilities

• Department Management - Overseeing workflows, developing policies and procedures, and ensuring compliance with regulations.
• Team Leadership - Managing, training, and developing staff, particularly those who may not have prior claims experience.
• Cross-functional Collaboration - Working closely with other departments on organizational initiatives and projects.
• Customer Service Excellence - Ensuring high-quality service to members, providers, and health plans.
• Process Improvement - Identifying opportunities to enhance efficiency, automation, and accuracy in claims processing.
• Compliance Management - Staying current with healthcare regulations and ensuring the department meets all requirements.

Qualifications

• 8+ years of experience in health plan/carrier claims or customer service management
• Strong knowledge of state and federal regulations related to claims administration
• Experience with claims adjudication principles and procedures
• Familiarity with medical terminology including CPT, HCPCS, and ICD-10 coding
• Leadership experience, particularly training and developing staff
• Comfort with technology, particularly claims processing systems

Mid-Senior level

Full-time

Finance and Sales

IT Services and IT Consulting