Manager, Claims Operations

About the role

UST HealthProof is looking for a Manager I, Claim Operations. The Claims Operations Manager I is responsible to develop and maintain metrics/reports/tools to support various claim initiatives and personnel. The Manager will provide execution and strategic expertise to support day to day inventory and claims initiatives’ success. The Manager will service as an integral part of the leadership team to help strategically plan for growth and develop ways to increase optimal operational efficiencies and quality of claims processing. Ensuring targets, goals and client expectations are met or exceeded.

Responsibilities

• Assess and manage claims inventory; track and manage inventory trends and proactively adjusts resource levers as needed to maximize productivity to meet inventory management goals
• Be solutions oriented; analyze data, proactively assesses business needs
• Apply subject matter expertise to the business of claims processing and operations
• Manage and coach individual contributor performance and quality using quantitative and qualitative data
• Independently identify and resolve team issues with appropriate escalation
• Train and coach staff and vendors on claims processes
• Motivate and lead team members in accordance with HealthProof values and objectives
• Proactively review and assess talent
• Use knowledge of CMS and regulatory claims processing guidelines to drive compliance in HealthProof claims processing policies and procedures
• Work with Business Analysts and Technical Writers to design and document workflows and business processes
• Recommend strategies for attaining and exceeding claims operations SLAs
• Recommend training assets and job aids to improve operational effectiveness

Requirements

• A minimum of 7 years of health insurance claims experience with progressive leadership responsibilities
• An ability to independently direct the implementation of complex business projects
• Working knowledge of other functions within insurance operations and shared services (benefits, enrolment, compliance, medical management, customer service etc.)
• Possesses an in-depth understanding of industry issues and opportunities and is able to share gained knowledge
• Effective communications: ability to obtain clear information and remove ambiguity as needed to arrive at shared expectations
• Capability to approach problems as challenges and deal with them constructively; promoting this approach with all team members
• Well-developed organizational habits
• Experience in MS Word, Excel, PowerPoint, MS Visio
• An operating knowledge of Lean Six Sigma and or AGILE, preferred

Pay

The annual US base salary range for this position is $65,000 to $85,000. This salary range may cover multiple career levels at HealthEdge. Final compensation will be determined during the interview process and is based on a combination of factors including, but not limited to, your skills, experience, qualifications and education.