Claims Manager

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

📋 Description

• Supervise Claims Supervisors, processing teams, claims processing workflows, queue management, and daily transaction activities.

• Ensure that claims processing is conducted accurately and promptly within contractual and regulatory deadlines.

• Conduct interviews, select, and hire candidates for positions in the Claims department.

• Manage employee performance by setting objectives, overseeing workloads, and tracking productivity, metrics, and quality.

• Oversee claims inventory and address any issues in collaboration with Claims Supervisors.

• Strategically plan and assign job responsibilities to employees while developing team goals and objectives.

• Ensure that quality and productivity standards are consistently monitored and that feedback is provided accordingly.

• Address aged claims and oversee claims adjustment initiatives.

• Present reviews of claims processing, policy updates, audit results, and related communications during team meetings.

• Identify areas for improvement and manage the implementation of operational enhancement plans.

• Support internal and external audit processes.

• Maintain departmental workflows, standard operating procedures, and employee performance evaluation methods.

• Communicate with internal stakeholders regarding outstanding or pending deliverables.

• Provide data, analysis, and solutions regarding processing trends, opportunities for improvement, concerns, turnaround times, and quality metrics to the Claims Executive Leadership Team.

• Perform additional duties as assigned.

⛳️ Requirements

• Bachelor's degree or an equivalent combination of education and experience.

• At least 5 years of supervisory or management experience leading a production team.

• A minimum of 3+ years of experience in developing claim enhancements, including auto-adjudication triggers, robotic process automation, and claims adjudication system logic.

• Familiarity with Medicare, Medicaid, and/or Commercial insurance terminology and advanced claims payment processes.

• Advanced skills in Microsoft Office applications, including Excel, Word, Adobe, and other Windows-based tools for data aggregation, analysis, trend monitoring, and reporting recommendations.

• Ability to work flexible hours to meet business requirements across all time zones.

• Exceptional listening skills along with strong verbal and written communication abilities.

• Exposure to or experience with CPT, HCPC, dental, and diagnosis coding.

• Understanding of general claims processing principles.

• Excellent attention to detail and accuracy.

• Strong organizational skills with the capability to manage multiple tasks and meet deadlines.

• Reliable internet connection; a minimum of 50 Mbps download and 10 Mbps upload speeds while hardwired and not on a VPN is required.

• A Master's degree in a related field is preferred.

• Experience in Dental/Vision insurance or in healthcare organizations is preferred.

🏝️ Benefits

• Competitive compensation package.

• Medical, dental, supplemental health, life, and vision coverage for you and your dependents with no waiting period.

• Life and disability insurance.

• 401(k) plan with company matching contributions.

• Tuition assistance programs.

• Paid parental leave.

• Backup family care services.

• Flexible time off policies.

• Flexible dress code and work location options.

• Employee Resource Groups.

• Opportunities for social responsibility and community volunteering.

• Engaging and meaningful work experiences.

• Dynamic, contemporary work environments that foster collaboration and creativity.