Assistant Manager of Claims Processing

About the role

WebTPA, a GuideWell Company, is a healthcare third-party benefit administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. The Assistant Manager of Claims Processing is responsible for managing a team of Claims Examiners for the day-to-day operations of claims.

Responsibilities

• Serve as SME and primary point of contact for all claims processing related questions
• Accountable for hiring new employees, including partnering with Talent Acquisition, conducting interviews, providing feedback, and approvals
• Manage an onboarding plan for new hires, coordinate with Talent Development Department training plans, check-ins, and progress reports
• Manage and review claims, open notes, and check backlog on a daily basis
• Assess and assign claims processing prioritization, make adjustments to ensure deadlines and performance guarantees are met
• Review established metrics for quality and accuracy of claims processed
• Partner with Internal Audit and Auditors in assessing metrics and areas of concern or improvement
• Coach employees on performance through regular 1:1 meetings and make recommendations to Claims Examiners and Senior Management
• Conduct performance appraisals
• Reward and recognize team members for successfully performing goals and objectives and foster a team environment upholding company mission, vision, and values
• Partner with HR on issuing disciplinary issues and terminations in compliance with established processes and procedures
• Serve as Timekeeper reviewing timecards, submit requests for OT to Sr. Manager & Leadership for approval, and review and approve or deny PTO requests based on business needs
• Process claims at the highest dollar threshold and review more complex items
• Investigate claims in question by members or clients
• Assist Manager with callbacks for members and providers
• Communicate directly with both clients and internal teams to resolve issues or concerns
• Complete claim testing for benefit changes, renewals, and new groups
• Review claim benefits issues with IT/Plan Build
• Update and create benefit grids as necessary
• Assist SilverSkills with any claim questions or audits

Requirements

• 2+ years related work experience as a claims examiner or adjudication experience on a computerized claims payment system in the healthcare industry
• 1+ years direct supervisory/management experience
• Related Bachelor’s degree or additional related equivalent work experience
• Proven judgment, decision-making skills, and the ability to think analytically
• Ability to learn quickly and multi-task
• Concise written and oral communication skills, including the ability to deal with conflict
• Experience in processing all types of medical claims
• Motivated with a sound work ethic
• Ability to maintain good rapport with clients, providers, and internal employees
• Excellent written and verbal communication
• Knowledge of all MS Office products
• Proficiency and experience with WebTPA systems
• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees

Benefits

• Medical, dental, vision, life and global travel health insurance
• Life insurance, Short- and long-term disability programs
• Leave programs to support personal circumstances
• 401(k) with employer contribution match
• Paid time off, volunteer time off, and 11 holidays
• Additional voluntary benefits options available
• Comprehensive wellness program