RCM Insurance Claims Manager

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

📋 Description

• Lead and oversee the claims process for diagnostic laboratory services from the initial claim submission to final resolution, ensuring timely and accurate reimbursements.

• Manage the review and resolution of denied, pending, and aging claims, ensuring comprehensive investigation and appropriate corrective actions.

• Ensure that claims are submitted and managed in compliance with payer requirements, billing guidelines, and regulatory standards.

• Collaborate with internal teams and external billing vendors to address complex claim issues and enhance reimbursement results.

• Monitor claims inventory, accounts receivable performance, and operational metrics to ensure service level objectives are met.

• Lead, mentor, and develop the Claims team, establishing clear performance expectations and driving accountability for productivity, quality, and reimbursement outcomes.

• Analyze claims and denial patterns, identify underlying causes, and implement process enhancements to minimize preventable denials and improve claim performance.

• Effectively communicate with payers, vendors, and internal stakeholders to resolve issues, provide updates, and support organizational goals.

• Prepare regular reports on claims activities, operational performance, reimbursement trends, and team productivity for leadership review.

• Coordinate system implementations, upgrades, and process enhancements related to claims workflows and billing operations, overseeing ongoing support and maintenance activities.

• Develop and sustain claims-related policies, procedures, training materials, and operational best practices.

• Additional responsibilities may be assigned. All tasks must be performed in a manner that reflects the company's Leadership Attributes and supports its Mission & Values.

⛳️ Requirements

• Bachelor's degree in healthcare administration, business, finance, or equivalent experience in a related field.

• 5–7 years of experience in laboratory billing, insurance claims, or revenue cycle management, with a preference for those who have led claims operations.

• Strong understanding of insurance claim processes, healthcare regulations, HIPAA, and compliance standards.

• Excellent critical thinking skills to identify root causes, resolve complex claim issues, and implement effective solutions.

• Advanced knowledge of payer requirements, claim adjudication processes, denial management, and reimbursement methodologies.

• Ability to think critically and work efficiently and responsibly in a collaborative environment with multiple demands and tight deadlines.

• Outstanding leadership, communication, and organizational skills.

• Capability to analyze data, identify trends, and implement operational improvements that enhance claims performance and reimbursement results.

• Understanding of industry-specific policies and regulations, including HIPAA requirements and payer compliance standards is preferred.

• Experience with Microsoft Office applications.

• Familiarity with AI tools and technologies, and the ability to leverage them for improved productivity, data analysis, reporting, workflow efficiency, and operational decision-making.

🏝️ Benefits

• Competitive compensation and benefits that align with local market practices and legal requirements in each country where we operate.