MANAGER, CLAIM OPERATIONS
POSITION SUMMARY
The Manager Claims Operations will independently monitor and manage the daily work and other functions within the Claim Processing team as well as training for new and existing claim department staff. Planning and maintaining workflows, procedures and policies that enable and encourage the optimum performance of the claim team.
ESSENTIAL FUNCTIONS
- Work with Human Resources to interview, select, hire, and employ an appropriate number of employees
- Coach, mentor, and develop staff, including training/overseeing new employees.
- Empower employees to take responsibility for their jobs and goals. Delegate responsibility and expect accountability and regular feedback
- Lead employees using a performance management and development process that provides an overall context and framework to encourage employee contribution and includes goal setting, feedback, and performance development planning
- Lead employees to meet Allied’s expectations for productivity, quality, and goal accomplishment
- Maintain employee work schedules including assignments, training, and paid time off
- Develop and implement detailed workflows to improve the consistency and accuracy of the staff
- Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Assist other departments on questions related to the payment of claims
- Monitor all reports including but not limited to Workflow Manager, pended claims, suspended claims and Inventory listings to ensure that all claims are handled timely and accurately
- Attend outside audits as needed to ensure accurate reporting.
- Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent
- Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed
- Actively engage, coach, counsel and provide timely, and constructive performance feedback
- Attend continuing education classes as required, including but not limited to HIPAA training
- Perform other duties and responsibilities, as assigned
EDUCATION
- Bachelor’s degree or equivalent work experience required
EXPERIENCE AND SKILLS
- A minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) required
- A minimum of 3 years’ experience at a Manager or Supervisor level with successfully demonstrated leadership competencies is required
- All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology
- Excellent written and verbal communication skills
- Exceptional time management skills and ability to prioritize work
POSITION COMPETENCIES
- Accountability
- Communication
- Action Oriented
- Timely Decision Making
- Building Relationships/Shaping Culture
- Customer Focus
PHYSICAL DEMANDS
- This is an office environment requiring extended sitting and computer work
WORK ENVIRONMENT