Claims Manager - Remote

Overview

The Claims Manager will lead the day-to-day operations of the claims department, ensuring high-quality service delivery, compliance with regulatory requirements, and alignment with organizational goals.

In Short

• Lead and manage the claims team to achieve optimal performance aligned with company goals.
• Oversee daily claims production, ensuring accuracy, timeliness, and compliance.
• Provide technical guidance on claim investigation, reserving, evaluation, and resolution.
• Prepare and deliver reports and analyses in accordance with defined standards.
• Identify strategic opportunities through financial analysis and cost/benefit evaluations.
• Collaborate with stakeholders to identify gaps and implement corrective strategies.
• Partner with Compliance and Risk teams to ensure adherence to regulatory requirements.
• Develop and implement performance metrics and accountability systems.
• Foster a culture of trust and continuous improvement within the claims department.
• Stay current on industry trends to improve claims management strategies.

Requirements

• Minimum 5 years of experience in medical claims analysis and adjudication.
• At least 3 years of leadership experience in a supervisor or manager role.
• Strong understanding of CPT, ICD-9, and general coding terminology.
• Proficiency in claims systems and analytical tools.
• Excellent communication and interpersonal skills.
• Strong organizational and time management skills.

Benefits

• Comprehensive medical, dental, vision, and life insurance coverage.
• 401(k) retirement plan with employer match.
• Health Savings Account (HSA) & Flexible Spending Accounts (FSAs).
• Paid time off (PTO) and disability leave.
• Employee Assistance Program (EAP).