Manager, Claims

Sanford Health • Fargo, ND

1d • Hybrid

About The Position

The Claims Manager is under the general supervision of the Sanford Health Plan Director of Claims, in the areas of health insurance claims submitted by providers and patients for processing. Responsible for the implementation and day-to-day performance of process activities related to claims research and resolution. The process includes the review and/or testing of claims, benefits and fee schedules to ensure claims process correctly. Accountable as a resource to all employees in the claims department as well as other departments in the organization. Responsible for the interviewing, hiring, discipline of employees and any other personnel issues that arise. Completes performance appraisals. Coordinates claims processing and adjustment activities within the claims department. Manages claims inventory, ensuring accurate and timely processing. Knowledge of various lines of business that the Sanford Health Plan services and how to differentiate services. Understands the details of professional and institutional claim processing which includes how benefits are assigned and pricing is calculated. Works to help develop and maintain claims policies and procedures. Must communicate effectively with a high level of diplomacy. Demonstrates analytical ability and a good awareness of pertinent details. Assimilates large amounts of information to maintain a broad knowledge base. Exercises good judgement in determining the best method for handling a variety of situations. Maintains good working relationships with staff, physicians, and enrollees. Handles pressure effectively. Maintains confidentiality. Other duties as assigned.

Requirements

• Three years in a team lead or management role in claims processing or similar environment required.
• Bachelor's degree preferred.

Nice To Haves

• Knowledge of various lines of business that the Sanford Health Plan services and how to differentiate services.
• Understands the details of professional and institutional claim processing which includes how benefits are assigned and pricing is calculated.
• Must communicate effectively with a high level of diplomacy.
• Demonstrates analytical ability and a good awareness of pertinent details.
• Assimilates large amounts of information to maintain a broad knowledge base.
• Exercises good judgement in determining the best method for handling a variety of situations.
• Maintains good working relationships with staff, physicians, and enrollees.
• Handles pressure effectively.
• Maintains confidentiality.

Responsibilities

• Implementation and day-to-day performance of process activities related to claims research and resolution.
• Review and/or testing of claims, benefits and fee schedules to ensure claims process correctly.
• Serve as a resource to all employees in the claims department as well as other departments in the organization.
• Interviewing, hiring, discipline of employees and any other personnel issues that arise.
• Completes performance appraisals.
• Coordinates claims processing and adjustment activities within the claims department.
• Manages claims inventory, ensuring accurate and timely processing.
• Develop and maintain claims policies and procedures.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager