What is your impact?
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.
What Will You Be Doing:
Supervisory responsibilities:
- Manages Claims Assistant Managers
- 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 meeting for updates and performance appraisals.
- Issues disciplinary measures in partnership with HR.
Primary contact for clients on day-to-day items and updates:
- 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). Occasionally