Senior Manager, Medical Claims
About The Position
Responsibilities • Measure individual, system and performance of the Medical Claims Departments; ensure operating standards are met and implement operational objective of the department • Review and correspond with vendors and Aetna partners on any claims related issues, to ensure all re-pricing are processed accurately and assist with re-pricing drug allowance on Medispan • Test new changes in the Medical Claims Processing System (QNXT); establish system functionality, configuration and evaluate workflow requirements • Resolve medical claims suspensions and responds to appeals; assist Supervisors and Staff with complex claims • Assess supervisors and their staff performance To provide feedback when necessary • Prepare departmental policies and procedures to ensure medical claims are processed accurately and in a timely manner; recommend system and policy changes • Implement department wide initiatives and design training programs; ensure staff has the knowledge to perform essential duties, comply with relevant regulations and acquire the skills to achieve goals and objectives • Supervise staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement • Develop, prepare, and analyze various reports regarding operations and productivity • Perform additional duties and projects as assigned by management Qualifications • Bachelor's Degree in Health Administration or Business Management required • Minimum of six (6) years relevant Medical Claims experience in a health benefits environment; to include two (3) years supervisory experience required • Advance level in Microsoft Word and Excel preferred • Extensive knowledge of medical claims processing, with extensive processing experience within a Taft-Hartley Fund CPT, ICD 10 and HCPCS • Excellent leadership skills and ability to direct and motivate staff to meet and exceed standards • Strong critical thinking, analytical and problem solving skills • Superb communication and interpersonal skills
Requirements
- Bachelor's Degree in Health Administration or Business Management required
- Minimum of six (6) years relevant Medical Claims experience in a health benefits environment; to include two (3) years supervisory experience required
- Extensive knowledge of medical claims processing, with extensive processing experience within a Taft-Hartley Fund CPT, ICD 10 and HCPCS
- Excellent leadership skills and ability to direct and motivate staff to meet and exceed standards
- Strong critical thinking, analytical and problem solving skills
- Superb communication and interpersonal skills
Nice To Haves
- Advance level in Microsoft Word and Excel preferred
Responsibilities
- Measure individual, system and performance of the Medical Claims Departments; ensure operating standards are met and implement operational objective of the department
- Review and correspond with vendors and Aetna partners on any claims related issues, to ensure all re-pricing are processed accurately and assist with re-pricing drug allowance on Medispan
- Test new changes in the Medical Claims Processing System (QNXT); establish system functionality, configuration and evaluate workflow requirements
- Resolve medical claims suspensions and responds to appeals; assist Supervisors and Staff with complex claims
- Assess supervisors and their staff performance To provide feedback when necessary
- Prepare departmental policies and procedures to ensure medical claims are processed accurately and in a timely manner; recommend system and policy changes
- Implement department wide initiatives and design training programs; ensure staff has the knowledge to perform essential duties, comply with relevant regulations and acquire the skills to achieve goals and objectives
- Supervise staff in accordance with established departmental and Human Resources guidelines and provisions of the Collective Bargaining Agreement
- Develop, prepare, and analyze various reports regarding operations and productivity
- Perform additional duties and projects as assigned by management
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
501-1,000 employees
