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Claim Examiner / Auditor Supervisor (Hybrid)
Vestra Miami - Doral, FL
posted about 1 month ago
About the position
We are seeking a dedicated and detail-oriented Claims Manager to oversee our claims processing operations. The ideal candidate will have a strong background in medical terminology, risk analysis, and negotiation skills. This role requires an individual who can effectively manage a team, analyze claims data, and ensure compliance with Medicare guidelines and medical coding standards. The Claims Manager will play a crucial role in enhancing our claims management processes while maintaining high levels of accuracy and efficiency.
Responsibilities
- Oversee the daily operations of the claims department, ensuring timely and accurate processing of claims.
- Analyze claims data to identify trends, discrepancies, and areas for improvement.
- Negotiate with insurance providers and other stakeholders to resolve claim disputes.
- Ensure compliance with Medicare regulations and medical coding requirements.
- Review medical records and documentation to validate claims submissions.
- Conduct risk analysis to mitigate potential losses related to claims processing.
- Provide training and support to team members on medical terminology, DRG (Diagnosis Related Group) coding, and best practices in claims management.
- Collaborate with other departments to streamline processes and improve overall efficiency.
Requirements
- Proven experience in claims management or a related field, preferably within the healthcare or insurance industry.
- Strong knowledge of Medicare policies, medical terminology, and medical coding practices.
- Familiarity with auto restoration processes is a plus.
- Excellent analytical skills with the ability to interpret complex data sets.
- Demonstrated negotiation skills with a track record of successful outcomes.
- Mechanical knowledge is beneficial for understanding related claims processes.
- Ability to work independently as well as part of a team in a fast-paced environment.
Nice-to-haves
- Experience with auto restoration processes.
Benefits
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Flexible schedule
- Health insurance
- Life insurance
- Paid time off
- Parental leave
- Retirement plan
- Vision insurance
