Manager of Claims Processing

About the role

The Manager of Claims Processing is accountable for achieving business results through the application of effective leadership and management processes with a special emphasis and focus on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits.

Supervisory Responsibilities

• Manages Claims Assistant Managers directly
• Directly accountable for hiring and promoting from within WebTPA
• Provides direction and coaching on performance of AMCS and their teams (direct and indirect reports)
• Conducts 1:1 meetings for updates and performance appraisals
• Issues disciplinary measures in partnership with HR

Primary Contact For Clients

• Manage client relationships as primary contact for daily items, including weekly conference calls and monthly board meetings
• Resolves claims issues by researching plan coverage, claims history, and routinely educating customers and members through a wide variety of calls and written inquiries
• Reports updates to the Sr. Manager Ops, and Director Ops
• Works in partnership with plan sponsors, members, and coworkers to meet and exceed customer expectations and requirements of the organization
• Direct contact with providers to resolve contract and payment issues

Monitors Client Performance Guarantees

• Responsible for internal reports indicating claims log, success factors behind metrics with suggested proposals based on feedback from client and analysis
• Consistently reviews team performance metrics in conjunction with client satisfaction and advises on areas for improvement and additional training necessary to be successful
• Partners with HR Talent Development for training initiatives on team specific to performance metrics and internal reporting and internal audits

Qualifications

• 4+ years related work experience in the claims administrative industry
• 2+ years direct supervisory/management experience
• Related Bachelor’s degree or additional related equivalent work experience
• Strong verbal and written presentation/communication skills
• Ability to handle confidential and sensitive information appropriately
• Comfortable working across operational departments throughout the organization and in direct contact with clients
• Microsoft Office skills are required, specifically Word, Excel, and Outlook
• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees
• Strong time and project management skills

Preferred Qualifications

• Minimum of 2 years WebTPA specific claims processing experience preferred

General Physical Demands

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities

• Must be able to travel to multiple locations for work (i.e., travel to attend meetings, events, conferences)