Manager, Medical Claims Operations
Based in Bothell, WA, this private equity sponsored organization is the largest and fastest-growing Third Party Administrator (TPA) in the United States. With over a half Century of benefit plan administration experience, 1,500+ team members, and 45 locations across the United States, this organization provides the technologies, services, systems, and support methodology to self-funded benefit plans to help meet the demands of increasingly complex and rapidly evolving regulatory changes in a cost-effective manner.
The Claims Manager oversees daily production and quality of the claims department processing medical and hospital claims. Works closely with the Director of Claims Operations to ensure all personnel are trained and developed according to their job description and work load. Oversee all claims processes which included but are not limited to adjustments, claims audits, claims projects and initiatives, claim reporting, claim system analysis and testing, recovery, and cost savings.
The Claims Manager is responsible for the operational activities and claims staff in accordance with Company guidelines, client needs, and legislative requirements.
- Manage staff, demonstrating leadership qualities consistent with management values and mission.
- Develop staff through performance management, goal setting, training, and effective employee relations.
- Oversee quality and quantity of work produced, insuring employees are held accountable and expectations are consistently met.
- Develop and manages staffing and departmental budget to insure efficient operation within budget guidelines.
- Responsible for making recommendations within a department or branch in the areas of compensation, staff selection, disciplinary action, complaints, staff performance appraisals, and similar supervisory duties.
- Develop, implements and monitors internal systems, policies and procedures to ensure operations are in compliance with client needs, new developments, regulations, and reporting requirements.
- Resolves customer/client service issues and coordinates successful implementation of new clients.
- Maintains communications and effective working relationships with clients, and responds to requests from clients, government agencies, unions, participants, attorneys, and consultants.
- Attends client meetings and interfaces directly with clients on claims-related issues to ensure client requirements and changes in benefit programs are implemented.
- Oversees internal systems, policies and procedures to ensure operations are in compliance with client needs, new developments, regulations, and reporting requirements.
- Applies established technology solutions and makes recommendations for use of technology to improve individual or small work group efficiency and effectiveness.
- Performs other similar and related duties as required.
The Successful Candidate
The successful candidate will demonstrate the knowledge, skills, and abilities necessary to perform the essential functions of this position in a fast-paced, high-accountability environment. This includes, but is not limited to the following competencies:
- 5 to 7 years of medical claims processing experience.
- 3+ years of experience in quality review/team leader function.
- Bachelor's degree preferred.
- Analytic ability and inductive thinking are required for the application of multiple, technical activities.
- Problem solving involves identification and analysis of diverse issues.
- Independent judgment is required to study previously established, often partially relevant guidelines; plan for various interrelated activities; and coordinate such activities within a work unit /division or while completing a project.
- Work is non-standard and widely varied requiring the interpretation and application of a variety of policies and procedures.
- Requires frequent external contacts to interpret and explain programs and complex matters that would require an in-depth knowledge of the subject matter.
- Proficient PC skills including intermediate to advanced Microsoft Word, Excel and Outlook skills including claims related software.
- Inspires trust and open communication.
- Excellent written and verbal communication skills.
- Promotes teamwork and collaboration.
- Quickly and effectively resolves conflict.
- Excellent organizational skills and attention to detail.
- Self-motivated and self-starting personality.
The Claims Manager will be a skilled member of the Claims Department. As such, they will receive a competitive compensation package, to include:
- Generous salary.
- Full suite of health benefits.
- Ability to participate in the company’s retirement plan.
- Opportunity for growth within the Nation’s largest and fastest-growing TPA!
Keywords: Claims Manager, Claims Operations Manager, Manager of Claims Operations, Claims Supervisor.