Manager of Claims
About The Position
The Manager of Claims at Avesis directly oversees Claims Supervisors, processing staff, and claims technology initiatives. This role administers claims processing functions and leads the development and performance of the Claims Processing team to ensure high-quality, timely outcomes. Responsibilities include workflow oversight, error-reduction initiatives, consistent execution of claim payment procedures, special projects, and supervisor performance. The Manager presents data, analysis, and solutions to the Claims Executive Leadership Team concerning processing trends, improvement opportunities, operational concerns, turnaround times, and quality benchmarks. The position oversees claims workflows, queue management, daily transactions, inventory, employee performance, productivity, and quality. It supports timely and accurate claim processing under contractual and regulatory timeframes, helps resolve aged claims and adjustment projects, participates in audits and procedure reviews, and communicates with internal stakeholders. The role is remote and requires internet service sufficient for essential duties: at least 50 Mbps download and 10 Mbps upload while hardwired and not using a VPN. Flexible hours may be needed to accommodate business needs across time zones.
Requirements
- Bachelor's degree or an equivalent combination of education and experience.
- At least 5 years of supervisory or management experience leading a production team.
- At least 3 years of experience leading or participating in the development of claim enhancements, including auto-adjudication triggers, robotic process automation, and claims adjudication system logic.
- Knowledge of Medicare, Medicaid, and/or commercial insurance terminology and high-level claims payment processes.
- Advanced proficiency with Microsoft Office products, including Excel and Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend, and report recommendations for operational performance.
- Ability to work flexible hours to accommodate business needs in all time zones.
- Excellent listening and verbal and written communication skills.
- Exposure to or experience with CPT, HCPC, dental, and diagnosis coding.
- Knowledge of general claims processing principles.
- Ability to manage competing priorities and meet tight deadlines.
- Strong attention to detail and accuracy.
- Strong organizational skills and ability to manage multiple tasks and meet deadlines.
- Reliable internet service of at least 50 Mbps download and 10 Mbps upload while hardwired and not using a VPN.
- Collegiality, relationship-building, approachability, helpfulness, mentoring, and support for team growth.
- Initiative and readiness to lead or act to achieve goals.
- Ability to communicate issues, concepts, and ideas clearly orally and in writing.
- Member-focused approach and commitment to making members feel valued.
- Ability to manage assignment details thoroughly without excessive oversight.
- Flexibility and responsiveness to new demands, changes, and situations.
- Critical thinking, troubleshooting, problem-solving, and multitasking skills.
- Integrity, ownership, responsibility, and ability to keep information confidential when required.
- Collaborative approach to finding workable solutions among differing or competing interests.
Nice To Haves
- Master’s degree in a related field; relevant experience may be considered in lieu of the degree.
- Experience within dental or vision insurance or healthcare organizations.
Responsibilities
- Directly oversee Claims Supervisors, claims support staff, processing workflows, queue management, daily transactional operations, and annual performance reviews.
- Apply knowledge of contracts, performance requirements, claims workflows, automated processes, and payment processes.
- Oversee timely and accurate claim processing within contractual and regulated timeframes.
- Interview, select, and hire applicants for Claims department positions.
- Manage employee performance, set goals, oversee workloads, and monitor productivity, metrics, and quality.
- Monitor claims inventory and help supervisors proactively address concerns.
- Assist with monitoring, planning, and assigning employee job requirements.
- Develop goals and objectives for supervised team members.
- Ensure quality and productivity standards are monitored and feedback is provided to frontline staff.
- Assist management and processors in resolving aged claims and handling claims adjustment projects.
- Present topics and participate in team meetings concerning processing reviews, policy and procedure updates, audit findings, and related communications.
- Identify opportunities and oversee implementation of plans to improve operations and outcomes.
- Support internal and external audit activity as needed.
- Participate in annual review and maintenance of departmental workflows and standard operating procedures, as well as employee performance review activity.
- Communicate promptly with internal Avesis stakeholders about pending or open deliverables.
- Present relevant data, analysis, and solutions to the Claims Executive Leadership Team about trends, improvement opportunities, concerns, turnaround times, and quality benchmarks.
- Perform other duties occasionally as assigned.
Benefits
- Medical, dental, supplemental health, life, and vision coverage for employees and dependents with no waiting period.
- Life and disability insurance.
- 401(k) with company match.
- Tuition assistance.
- Paid parental leave.
- Backup family care.
- Flexible time off.
- Flexible work location policies.
- Bonuses and commission may be available.
- Competitive compensation package.
- Employee Resource Groups supporting inclusion and diversity.
- Meaningful and challenging work opportunities.
- Dynamic, modern work environments promoting collaboration and creativity.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
