About this role
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