The Claims Manager will provide leadership within the claims department, focusing on enhancing productivity, maintaining high-quality standards, and ensuring accuracy in claims processing.
Requirements
- Must effectively manage the claims inventory and provide timely and accurate claims and encounter processing.
- Overall accountability for ensuring the design and development of claims workflow, policies and procedures as well as make appropriate recommendations that will positively impact operational effectiveness.
- Responsible for meeting and exceeding operational productivity standards and for ensuring that claims are processed within the timeliness guidelines, while ensuring accuracy and quality
- Assure compliance with all contractual and regulatory agencies for all product lines and governing bodies.
- Ensure proper utilization of human and system resources to achieve stated performance objectives for productivity, quality, data integrity and financial controls within budgetary constraints.
- Participates in the review and revisions of productivity and quality standards, as needed.
- Aids senior management in the implementation of new business objectives, EZ-Cap upgrades, and other technical and vendor implementations related to claim processing.
- Monitors inventory or other reports daily to ensure adequate resources are applied to maintain departmental goals of timeliness and quality.
- Determine areas within the department requiring concentrated training efforts and plan appropriate actions to address training needs.
- Participate in organizational planning, including development and revision of action plans and outcomes evaluation as appropriate.
- Oversee department activities to ensure health plan and regulatory compliance is maintained.
- Develop and modify policies and procedures, as needed.
- Responsible for a full range of activities which ensure the operational effectiveness and excellence of the claims department.
- Participate with other departments and cross-functional work groups on issues related to departmental and organizational efficiencies.
- Provide support to staff in efforts to maximize efficiencies of staff.
- Assist in the development of automated solutions to prevent adjudication errors.
- Develop departmental and individual goals.
- Assure staff has the information and tolls necessary to perform their functions.
- Provide Leadership with feedback regarding departmental functions.
- Interact with internal departments to correct procedural and system problems.
- Monitor productivity and accuracy of unit staff as they adjudicate, adjust, perform analysis, and research claim projects.
- Actively participates in the recruiting, hiring and performance management of claims staff.
- Other related duties as assigned.
Benefits
- Medical
- Dental
- Vision
- Simple IRA Plan
- Employer Paid Life Insurance
- Employee Assistance Program
