Claims Manager
$55k - $80kHawaii-Western Management Group
Summary
- Oversees the operation of the Claims Department and ensures the department meets targets with respect to turnaround time, accuracy, and other benchmarks.
- Supervises department employees including hiring, training, coaching, and developing employees; assigning work; and evaluating performance.
- Establishes department policies and procedures including processing guidelines to ensure efficiency, accuracy, and consistency in accordance with Senior Management intent, Federal and State mandates, insurance industry standards, and plan documents.
- Maintains and updates health plans in the claims system.
- Updates the claims system after new edit releases and other updates.
- Generates system reports and oversees the preparation of daily, weekly, monthly, and other productivity reports to monitor claim processing standards and timelines and assist in workflow distribution.
- Keeps current with industry changes and how they affect claims processing.
- High school diploma or GED
- Excellent organizational, analytical, and time management skills
- Strong attention to detail
- Strong decision-making, leadership, presentation, problem-solving, and oral and written communication skills
- Able to consistently meet deadlines
- Effectively present information in one-on-one and small group situations to customers, clients, Senior Management, and other employees of the Company
- Intermediate-level proficiency in Microsoft Word and Excel
- College degree in Business Administration, Healthcare Management or related field; five years of experience in claims supervision or management or related experience; or equivalent combination of education and experience
- Proficient in medical terminology, medical billing, and medical coding
- Thorough knowledge of claims administration, regulations, and processing systems
Vacancy posted 4 days ago
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