Manager Claims
Amerihealth Caritas • , 3d
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Manager Claims
Amerihealth Caritas•,
About The Position
The Manager of Claims oversees and coordinates operational activities within the Claims Unit, including claims processing, provider claims services, research, and projects. The role manages day-to-day departmental operations, ensures priorities and tasks are completed accurately and on time, and addresses operational issues using established processes, subject matter expertise, and sound judgment. The Manager ensures departmental performance standards and Service Level Agreements (SLAs) are consistently met; coaches and develops team members to achieve performance goals; monitors employee performance; and makes recommendations and decisions regarding promotions and disciplinary actions. The role also assists with the department's operating budget and identifies opportunities to control costs, increase productivity, improve quality, and enhance revenue. Responsibilities include hiring and onboarding operations associates; providing ongoing coaching, career development, and professional development opportunities; keeping the team informed about relevant industry trends, regulatory requirements, and developments; and supporting and managing internal and customer-initiated audits, regulatory reviews, and customer certifications, including HEDIS and NCQA. The Manager oversees operational programs and reporting to identify performance improvements and partners with Workforce Management to allocate staffing resources according to production needs and SLA requirements.
Requirements
- Bachelor's degree or an equivalent combination of education and relevant work experience.
- At least 3 years of experience in healthcare, managed care, or the insurance industry.
- At least 5 years of management experience.
- Previous claims management experience.
Responsibilities
- Oversee and coordinate Claims Unit operations, including claims processing, provider claims services, research, and projects.
- Manage day-to-day departmental operations and ensure priorities and tasks are completed accurately and on time.
- Identify and resolve operational issues using established processes, subject matter expertise, and sound judgment.
- Ensure departmental performance standards and Service Level Agreements (SLAs) are consistently met.
- Coach and develop team members to meet or exceed individual and departmental performance goals.
- Monitor employee performance and make recommendations and decisions regarding promotions and disciplinary actions.
- Assist with development and management of the department's operating budget.
- Identify opportunities to control costs, increase productivity, improve quality, and enhance revenue.
- Manage hiring and onboarding of operations associates.
- Provide ongoing coaching, career development, and professional development opportunities to new and existing team members.
- Maintain knowledge of industry trends, regulatory requirements, and relevant developments, and communicate updates to the team.
- Support and manage internal and customer-initiated audits, regulatory reviews, and customer certifications, including HEDIS and NCQA.
- Manage operational programs and reporting to identify opportunities to improve production, quality, and overall performance.
- Partner with Workforce Management to ensure staffing resources are allocated appropriately based on production needs and SLA requirements.
Benefits
- Remote work options and hybrid work schedules
- Competitive pay
- Paid time off
- Paid holidays
- Volunteer events
- Health insurance coverage for the employee and dependents starting Day 1
- 401(k) retirement savings plan
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Manager
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