Manager of Medical Care Management - Eastern Alliance

ProAssurance•Lancaster, PA

1d•Hybrid

About The Position

An exciting opportunity exists to join the ProAssurance family of companies! Our mission is powerful and simple: We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose ProAssurance? At ProAssurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, leadership, relationships, and enthusiasm—and want to build their career with a great company where they can be their authentic self and feel valued, recognized, and rewarded for their contributions. ProAssurance specializes in healthcare professional liability, products liability for medical technology and life sciences, legal professional liability, and workers' compensation insurance. We are an industry-leading specialty insurer, with job opportunities in much of the contiguous United States. This position supports our workers' compensation line of business, Eastern Alliance, and is based in Lancaster PA. This position will report to the office daily for initial training followed by a hybrid work arrangement thereafter. The Medical Care Management Manager oversees all aspects of medical billing operations related to workers’ compensation claims. This role ensures accurate, timely, and compliant processing of medical bills, manages vendor relationships, and leads a team responsible for adjudicating bills according to state regulations, fee schedules, and company policies. The manager serves as a subject matter expert on WC billing practices and collaborates with internal and external stakeholders to optimize cost containment and operational efficiency.

Requirements

Bachelor’s degree with a minimum of five years of experience working in Workers’ Compensation Claims or similar capacity.
High school diploma or GED with a minimum of thirteen years of experience working in related field can replace the bachelor’s degree requirement.
Minimum five years of experience managing a medical billing team is required.
Attention to detail in processing information, establishing priorities, and meeting deadlines.

Nice To Haves

Advanced certification such as CPC® or similar credentials is preferred.
Proven track record of implementing process improvements and achieving measurable results in medical cost containment.
Strong leadership and interpersonal skills, with the ability to motivate and empower team members to achieve organizational goals.
Excellent analytical skills and attention to detail, with the ability to analyze complex data and make data-driven decisions.

Responsibilities

Provide guidance, support, and growth opportunities for staff.
Create and facilitate a team environment within the medical bill unit.
Establish performance objectives and provide regular feedback and conduct annual performance reviews for staff.
Coordinate and oversee the hiring of new staff and facilitate or conduct orientation for staff members; coordinate formal training programs; assign staff to special projects and oversee workflow and workload of staff; run regular unit meetings.
Directly oversee the day-to-day operations of the medical billing unit in accordance with Company standards and legal and statutory requirements.
Work with the Director of Medical Care Management to develop and implement comprehensive strategies for managing and maintaining medical costs trends in the workers' compensation claims process, while ensuring high-quality and expediency of care is maintained.
Manage relationships with strategic partners, which may include negotiating pricing, ensuring network/coverage adequacy, identifying and onboarding new vendors, or performing comparison analysis.
Meet with strategic partners to identify new programs that will help contain medical partners, which may include comparison analysis.
Work with Director of Medical Care Management to monitor and manage performance of vendor partners.
Manage the implementation of cost containment programs and using data to guide decision-making.
Review and distribute monthly reports and results; evaluate and report monthly unit results; make recommendations and adjustments when necessary.
Collaborate with regional teams and other departments.
Identify opportunities for improving efficiency and effectiveness in processes, procedures, and workflows.
Conduct regular audits and quality assurance reviews to ensure the integrity and accuracy of bill payments.
Assist with company projects as assigned and continue professional growth and development through attendance and participation in insurance/medical related events/functions, seminars, classes, and conferences.