Manager of Claims Processing

GuideWell•Irving, TX

About The Position

The Manager of Claims Processing is accountable for achieving business results through the application of effective leadership and management processes with a special emphasis and focus on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits.

Requirements

4+ years related work experience in the claims administrative industry
2+ years direct supervisory/management experience
Related Bachelor’s degree or additional related equivalent work experience
Strong verbal and written presentation/communication skills.
Ability to handle confidential and sensitive information appropriately.
Comfortable working across operational departments throughout the organization and in direct contact with clients.
Microsoft Office skills are required, specifically Word, Excel, and Outlook.
Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.
Strong time and project management skills.

Nice To Haves

Minimum of 2 years WebTPA specific claims processing experience preferred.

Responsibilities

Manages Claims Assistant Managers
Directly accountable for hiring and promoting from within WebTPA.
Provides direction and coaching on performance of AMCS and their teams (direct and indirect reports).
Conducts 1:1 meeting for updates and performance appraisals.
Issues disciplinary measures in partnership with HR.
Manage client relationships as primary contact for daily items, including weekly conference calls and monthly board meetings
Resolves claims issues by researching plan coverage, claims history, and routinely educating customers and members through a wide variety of calls and written inquiries.
Reports updates to the Sr. Manager Ops, and Director Ops.
Works in partnership with plan sponsors, members, and coworkers to meet and exceed customer expectations and requirements of the organization.
Direct contact with providers to resolve contract and payment issues.
Responsible for internal reports indicating claims log, success factors behind metrics with suggested proposals based on feedback from client and analysis.
Consistently reviews team performance metrics in conjunction with client satisfaction and advises on areas for improvement and additional training necessary to be successful.
Partners with HR Talent Development for training initiatives on team specific to performance metrics and internal reporting and internal audits.