Claims Processing Director plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director requires a bachelor's degree. Typically reports to top management. The Claims Processing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)
Job Summary: The Claims Examiner is detail-oriented and will be responsible for reviewing and adjudicating health insurance claims for all products and all lines of business, including but limited to Medicare, Self-Funded, Fully Insured, ensuring accuracy compliance with policies and regulations and timely settlements. This role involves assessing claims, verifying information, and communicating effectively with internal stakeholders, members, providers and their office staff and other insurance companies.
Qualifications and Requirements:
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0 Claims Processing Director jobs found in Reno, NV area