Manager, Claims Processing

Allied Benefit Systems•Chicago, IL

10d•$70,000 - $85,000•Remote

About The Position

The Manager of Claims Processing leads teams responsible for processing claims in accordance with network and client Service Level Agreements, Plan Documents, regulatory standards, and established policies and procedures. The role manages claim inventories in a fast-paced, high-growth environment and supports strategies and enhancements to improve claims processing and the member experience. The manager monitors inventory, productivity, and quality; leads efforts to reduce inventory; oversees network, product, and client performance requirements; and reviews elevated-authority claims. The role also supports new clients and products, resolves escalated issues with internal stakeholders, participates in outside audits, and develops strategies aligned with company goals. The manager leads, coaches, and develops employees, including setting expectations, providing resources and training, conducting one-on-ones and performance appraisals, and providing timely feedback. This is a remote position. Employees must have cable broadband or fiber internet with at least 100 Mbps download and 25 Mbps upload speeds. The work involves extended sitting and computer use.

Requirements

Bachelor’s degree or equivalent work experience.
At least 5 years of medical claims analysis and adjudication experience, including dental and vision claims analysis.
Demonstrated understanding of claims management systems and platforms.
Strong analytical and technical claims expertise across relevant lines of business, CPT, HCPCS, and ICD-10 coding, Coordination of Benefits (COB), and medical terminology.
Excellent written and verbal communication skills.
Strong time-management skills and ability to prioritize work.
Strong problem-solving and conflict-resolution skills, including the ability to handle sensitive client escalations.
Demonstrated leadership competencies and supervisory-level experience; the number of years is not specified.

Responsibilities

Monitor inventory, productivity, and quality reports across books of business to ensure claims are handled accurately and on time.
Lead data-driven initiatives to manage and reduce inventory, improve forecasting, and solve problems.
Oversee network, product, and client performance requirements, including service excellence, compliance, and audit requirements.
Manage elevated-authority claim reviews and release claims accurately and promptly within the Manager role’s dollar authority limit.
Provide comprehensive support for new clients and products across books of business.
Collaborate with internal stakeholders to resolve escalated client and broker issues and improve workflow efficiency and accuracy.
Attend outside audits as needed to ensure accurate reporting.
Develop and implement strategies aligned with company goals and objectives.
Attend required continuing education, including HIPAA training, and apply applicable privacy and security laws and regulations, including HIPAA and HITECH.
Lead, coach, motivate, and develop employees; conduct one-on-one meetings and performance appraisals, support growth opportunities, and attract new talent.
Communicate expectations and provide employees with the training, resources, and information they need to succeed.
Engage, coach, counsel, and provide timely, constructive performance feedback.
Perform other duties as assigned.