Manager, Claims Processing

Allied Benefit Systems•Chicago, IL

6d•$70,000 - $85,000•Remote

About The Position

The Manager of Claims Processing will lead teams responsible for ensuring that claims are processed according to network and client Service Level Agreements and in accordance with Plan Documents, Regulatory standards, and established policies and procedures. The Manager of Claims Processing is responsible for management of all claim inventories and leading teams in a fast paced, high growth environment that demands strong decision making, adaptability, and effective cross functional coordination. Additionally, this position will support strategies and enhancements that are implemented to improve the claims process and enhance member experience.

Requirements

A minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) required
A minimum of years’ experience at a supervisor level with demonstrated leadership competencies.
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
Exceptional time management skills and ability to prioritize work
Strong problem solving and conflict resolution skills and ability to handle sensitive client escalations

Responsibilities

Monitor inventory, productivity, and quality reports for all books of business to ensure that all claims are handled timely and accurately
Lead initiatives to manage/reduce inventory levels through data driven analysis, forecasting improvements, and innovative problem solving.
Oversee key networks, products, and individual client performance requirements with a focus on service excellence, performance compliance, and audit requirements
Manage elevated authority claim reviews to ensure appropriate handling; release claims accurately and timely in conjunction with dollar authority limit set for Manager role
Provide comprehensive support for new clients and products across all books of business
Collaborate with internal stakeholders to resolve, address escalated client/broker issues, and streamline workflows for better efficiency and accuracy
Attend outside audits as needed to ensure accurate reporting
Develop and implement strategies that align with the company’s overall goals and objectives.
Attend continuing education classes as required, including but not limited to HIPAA training.
Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto
Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed.
Actively engage, coach, counsel and provide timely, and constructive performance feedback.
Other duties as assigned