Manager, Claims (Self-Funded)

The Self-Funded Claims Manager is responsible for monitoring, educating, training and managing the Self-Funded Claims unit. The Manager will also assist other units with any claims payment concerns; help coordinate and assist other departments with special projects; and work with other Operations Managers for staff education, communication, issues and procedures.

Required:

1. Bachelor’s Degree or equivalent (5) years program experience.
2. Must be able to work on several projects concurrently.
3. Must have excellent organizational skills, initiation, motivation and the ability to interact well with others.
4. Must be proficient in personal computer software applications such as Word and Excel spreadsheets.
5. Must have strong oral and written communication skills.
6. Must have cultural sensitivity.
7. Must have leadership qualities.
8. Own transportation is required.
9. Must be willing to learn any new software programs to assist with daily tasks.

Desired:

1. Proven ability to manage projects and produce deliverables within established timeframes.
2. Previous claims processing experience.
3. Previous experience with the ability to work independently.
4. Previous claims leadership experience.

Certification in medical coding. 

Responsibilities:

1. Manage and monitor claims analysts to meet guidelines and regulations.
2. Coach, counsel, discipline, mentor and train unit staff as needed so as to promote expertise of positive morale within the unit team.
3. Prepare any monthly or quarterly reports as needed.
4. Create and review policies and procedures as needed or at meets on an annual basis.
5. Create and submit any member or provider newsletter articles.
6. Coordinate internal training for The Health Plan staff whenever needed.
7. Participate in any internal and/or external audits as needed.
8. Monitor day-to-day operations to ensure compliance.
9. Attend appropriate training or meetings as required.
10. Coordinate any claims audits internal and external.
11. Review and approve when appropriate vacations and time off for unit staff.
12. Participate on the Claims Compliance Committee and other committees as requested.
13. Complete Employee evaluations.
14. Initiate, review and monitor employee computer/system capabilities.
15. Consistently displays a positive attitude and acceptable attendance.
16. Complete company training as required (i.e. Compliance, FWA, HIPAA, DSNP, etc..

Read Full Description