Claims Manager

Responsibilities Department Management - Overseeing workflows, developing policies and procedures, and ensuring compliance with regulations. Team Leadership - Managing, training, and developing staff, particularly those who may not have prior claims experience. Cross-functional Collaboration - Working closely with other departments on organizational initiatives and projects.

Customer Service Excellence - Ensuring high-quality service to members, providers, and health plans. Process Improvement - Identifying opportunities to enhance efficiency, automation, and accuracy in claims processing. Compliance Management - Staying current with healthcare regulations and ensuring the department meets all requirements.

Qualifications 8+ years of experience in health plan/carrier claims or customer service management Strong knowledge of state and federal regulations related to claims administration Experience with claims adjudication principles and procedures Familiarity with medical terminology including CPT, HCPCS, and ICD-10 coding Leadership experience, particularly training and developing staff Comfort with technology, particularly claims processing systems Seniority level Mid-Senior level Employment type Full-time Job function Finance and Sales Industries IT Services and IT Consulting #J-18808-Ljbffr