Claims Manager

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Uphold HIPAA/PII standards to guarantee the confidentiality of all communications and documents.

• Act as a bridge between departments, vendors, and clients to facilitate collaborative progress.

• Possess a robust understanding of customer business operations.

• Showcase strategic business insight in decisions impacting the bottom line.

• Create and provide precise and timely reports.

• Aid in troubleshooting technical issues.

• Serve as an exemplary model in embodying core customer service values.

• Foster continuous learning, personal growth, and accountability among team members.

• Deliver prompt and comprehensive responses to both internal and external customers.

• Address member and group inquiries regarding plans/guidelines or claims within 24 hours.

• Refer complex issues to the appropriate channels.

• Support the processing and resolution of escalated matters.

• Ensure team adherence to service standards.

• Monitor trends within the assigned scope and notify relevant parties of any deviations from quality benchmarks.

• Formulate and implement plans to achieve established objectives.

• Provide ongoing feedback to enhance and optimize quality performance.

• Collaborate across departments to refine or streamline processes.

• Stay informed about industry trends and seek out new data sources.

• Innovate and refine internal processes to elevate overall quality.

• Conduct regular performance assessments of staff and offer continuous feedback and coaching as needed.

• Address and guide employees on behavioral or performance issues and implement corrective measures as necessary.

• Clarify and enforce company policies necessary for team members to fulfill their roles effectively.

• Allocate and supervise departmental workloads to ensure sufficient coverage while maintaining quality and service standards.

• Oversee both new and ongoing training efforts and update training manuals as required.

• Organize and actively engage in departmental meetings.

⛳️ Requirements

• College degree or equivalent is mandatory.

• A degree in Medical Billing and Coding or a related field is preferred.

• Familiarity with medical terminology is preferred.

• 7-10 years of experience as a Claims Examiner or equivalent is essential.

• 4-7 years of management experience is required.

🏝️ Benefits

• Health insurance coverage.

• 401(k) matching contributions.

• Paid time off.

• Flexible work arrangements.

• Opportunities for professional development.