Manager, Claims Operations

Palmetto GBA•Augusta, GA

1d•Onsite

About The Position

Manages a team of associates responsible for the accurate and timely processing and adjudication of claims. This position is full-time (40-hours/week) Monday-Friday in a typical office environment, working an 8-hour shift scheduled during normal business hours of 8:30AM-5:30PM. The role is located at 2743 Perimeter Parkway, Augusta, GA 30909. Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina, is a healthcare service administrator and one of the nation’s largest providers of high-volume medical claims and transaction processing. The company provides services and technology solutions to improve and streamline healthcare administration for government and corporate entities, offering a wide range of services requiring a diverse workforce and expansive areas of expertise from data analytics, administrative and workflow services to advanced systems. To help associates succeed and reach their professional goals, Palmetto GBA offers training classes and programs that help employees prepare for leadership positions and provides tuition assistance for education advancement. Palmetto GBA acknowledges associates’ hard work and dedication with awards and financial incentives. The company understands the value of a diverse and inclusive workplace and strives to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of the company.

Requirements

Bachelor's Degree (Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience; Equivalency not applicable for the Celerian Group, Bachelor's degree required.)
4 years of claims processing experience, including either 2 years of lead or supervisory experience OR 2 years of equivalent military experience in grade E4 or above
Analyzes claims deferrals
Diagnoses claims issues
Enters claims data
Reviews work from others
Uses sound reasoning when processing claims

Nice To Haves

Microsoft Office

Responsibilities

Monitors and evaluates one or more units to ensure the accurate and timely processing of claims.
Develops effective claims processing standards that incorporate the use of automated claims systems and other technology solutions.
Ensures compliance with all applicable laws, regulations, and contract requirements while meeting performance expectations.
Monitors all reports and quality audits to ensure the efficient operation of the department.
Ensures proper training for new and current staff.
Maintains a high level of customer service with all internal and external customers.
Interacts regularly with internal departments for planning, training, and management purposes.