Manager, Claims Operations

Palmetto GBA•Augusta, GA

2d•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. You will work an 8-hour shift scheduled during our normal business hours of 8:30AM-5:30PM. This role is located at 2743 Perimeter Parkway, Augusta, GA 30909. Palmetto GBA is a healthcare service administrator and one of the nation’s largest providers of high-volume medical claims and transaction processing. We provide services and technology solutions to improve and streamline healthcare administration not only for government but also for corporate entities. We offer a wide range of services that require a diverse workforce and expansive areas of expertise from data analytics, administrative and workflow services to advanced systems.

Requirements

Bachelor's Degree
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.