Description: Under administrative direction, responsible for managing the functions and activities in the Claims Department to insure timeliness and propriety of claims payments. The manager is responsible for ensuring that claims are processed and adjudicated in a timely and accurate manner by setting department goals and objectives and monitoring the work flow. The manager will provide leadership and guidance for establishing production and work flow systems, setting production and quality standards, defining all operating policies and procedures and claims processing guidelines.
Requirements: Six (6) years of management level medical claims payment processing experience OR Bachelor's degree from an accredited school or equivalent in business administration or related field AND four (4) years of administrative or supervisory experience in a medical claims payment processing operation OR any equivalent combination of training and experience. Health maintenance organization (HMO) and Medicaid claims processing experience is highly desirable. Knowledge of computerized on-line data entry systems; organizational structure of medical claims processing; methods and procedures utilized in medical claims processing; supervisory and training techniques; medical terminology; medical reimbursement methodologies. Ability to adapt to a rapidly evolving work environment; work independently and manage multi-task responsibilities; communicate with a variety of personnel and providers; prepare a variety of comprehensive statistical and narrative reports; effectively supervise and train staff. Possession of valid driver’s license and proof of State required auto liability insurance. Required Travel Up to 10%
We have an excellent benefit package to include: health care, dental, life, 457b and 401a plan, and other supplemental benefits. As a condition of employment, a satisfactory drug test and background check are required. E.O.E.