Responsibilities
- Department Management - Overseeing workflows, developing policies and procedures, and ensuring compliance with regulations.
- Team Leadership - Managing, training, and developing staff, particularly those who may not have prior claims experience.
- Cross-functional Collaboration - Working closely with other departments on organizational initiatives and projects.
- Customer Service Excellence - Ensuring high-quality service to members, providers, and health plans.
- Process Improvement - Identifying opportunities to enhance efficiency, automation, and accuracy in claims processing.
- Compliance Management - Staying current with healthcare regulations and ensuring the department meets all requirements.
Qualifications
- 8+ years of experience in health plan/carrier claims or customer service management
- Strong knowledge of state and federal regulations related to claims administration
- Experience with claims adjudication principles and procedures
- Familiarity with medical terminology including CPT, HCPCS, and ICD-10 coding
- Leadership experience, particularly training and developing staff
- Comfort with technology, particularly claims processing systems
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Finance and Sales
Industries
IT Services and IT Consulting
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