Medical Claims Review Manager jobs in Hayward, CA

Medical Claims Review Manager oversees the performance, productivity, and quality of the medical claims review staff. Responsible for hiring, training, and firing medical claims review staff. Being a Medical Claims Review Manager evaluates medical claims review processes and recommends process improvements. Serves as a technical resource for all medical review workers. Additionally, Medical Claims Review Manager typically requires an RN or BSN. Requires a bachelor's degree. Typically reports to a head of a unit/department. The Medical Claims Review Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Medical Claims Review Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)

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Claims Manager
  • Health Services & Benefit Administrators - (HS&BA, Inc.)
  • Dublin, CA FULL_TIME
  • ```Job Overview```
    We are seeking a highly skilled and experienced Claims Manager to join our team. As a Claims Manager, you will be responsible for overseeing the entire claims process and ensuring efficient and accurate handling of claims. This is a critical role that requires strong leadership, excellent communication skills, and a deep understanding of claims management.

    ```Responsibilities```
    - Manage a team of claims adjusters and ensure they are meeting performance goals
    - Develop and implement strategies to improve claims processing efficiency
    - Review and analyze claims data to identify trends and areas for improvement
    - Collaborate with other departments to resolve complex claims issues
    - Ensure compliance with regulatory requirements and company policies
    - Provide guidance and support to adjusters on complex or high-value claims
    - Investigate potential fraud or suspicious activity related to claims

    ```Experience```
    To be successful in this role, you should have the following experience and skills:
    - Minimum of 10 years of experience in health and welfare benefit plan administration preferably in a multi-employer environment.

    - Strong knowledge of insurance policies, procedures, and regulations
    - Experience with ICD-9 coding or medical coding is preferred
    - Excellent analytical and problem-solving skills
    - Strong leadership abilities with the ability to motivate and inspire a team
    - Exceptional communication skills, both written and verbal

    If you are a highly motivated individual with a passion for claims management and have the required experience, we encourage you to apply for this position. We offer competitive compensation packages and opportunities for career advancement.

    Please note that only qualified candidates will be contacted for further consideration.

    Job Type: Full-time

    Pay: $97,550.00 - $120,000.00 per year

    Benefits:

    • 401(k)
    • Dental insurance
    • Employee discount
    • Flexible schedule
    • Health insurance
    • Life insurance
    • Paid time off
    • Parental leave
    • Vision insurance

    Schedule:

    • 8 hour shift
    • Monday to Friday

    Supplemental pay types:

    • Bonus opportunities

    Ability to Relocate:

    • Dublin, CA 94568: Relocate before starting work (Required)

    Work Location: Hybrid remote in Dublin, CA 94568

  • 3 Days Ago

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Claims manager
  • Five Star Cleaners
  • Berkeley, CA FULL_TIME
  • Claims Manager Are you ready for a new career? One that will allow you to help people on a daily basis One that will challenge you every day. One that will require you to constantly learn and grow as ...
  • 4 Days Ago

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RN, RN - Utilization Management/Review - Travel
  • Excel Medical Satffing
  • Walnut Creek, CA FULL_TIME
  • Details Travel Job Type RN Profession RN - Utilization Management/Review Specialty Shift Details 08:00 AM - 05:00 PM Shift Job Order Details 03/28/2022 Start Date 06/25/2022 End Date 13 Week(s) Durati...
  • 19 Days Ago

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Technical Coach
  • Sport Clips - Manager - CA821
  • Walnut Creek, CA FULL_TIME
  • Sport Clips Haircuts is Hiring! Do What You Love. Love What You Do. JOB DESCRIPTION As an Technical Coach (Hair Stylist Educator), you play an important role in developing our Teams by ensuring every ...
  • 10 Days Ago

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Store Manager
  • Garage clothing-Store Manager-Broadway Plaza
  • Walnut Creek, CA FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 10 Days Ago

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Co Manager - Broadway Plaza Walnut Creek
  • Co Manager-Broadway Plaza Walnut Creek, Ca
  • Walnut Creek, CA FULL_TIME
  • Seize the opportunity to join a global fashion retailer with two brands at the heart of its success, Garage and Dynamite, selected as one of Montreal's Top Employers 2020 and as one of Canada’s Top em...
  • 10 Days Ago

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0 Medical Claims Review Manager jobs found in Hayward, CA area

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Indpendent Living Skills Instructor Case Management
  • ACTION INDEPENDENCE MOTIVATION SUPPORT
  • San Leandro, CA
  • Job Description Job Description Are you interested in a position that involves helping individuals with intellectual/dev...
  • 3/28/2024 12:00:00 AM

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TEMP - Grievance Resolution Specialist (Provider)-RTF 2226, RTF 2221
  • Info Way Solutions LLC
  • Fremont, CA
  • TEMP - Grievance Resolution Specialist (Provider)(6) Posted Date 12/5/2023 Department(s): Grievance & Appeals Resolution...
  • 3/28/2024 12:00:00 AM

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TEMP - Personal Care Coordinator
  • Info Way Solutions LLC
  • Fremont, CA
  • TEMP - Personal Care Coordinator (1) Department(s): Case Management Reports to: Supervisor, Case Management Hourly: $20....
  • 3/28/2024 12:00:00 AM

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Technical Support Specialist (Remote East)
  • Suki AI, Inc.
  • Redwood City, CA
  • **Technical Support Specialist (Remote East)** at Suki Redwood City Suki is creating a new category in the health-tech s...
  • 3/27/2024 12:00:00 AM

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Medical Records Tech- Mental Health 152
  • Telecare Corp.
  • Oakland, CA
  • "They made it easier for me to live, breathe, eat, and stay clean. Without them, I'd be waiting somewhere, waiting for s...
  • 3/27/2024 12:00:00 AM

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Mentor
  • Stepping stones independent living llc
  • Hayward, CA
  • Job Description Job Description Position Overview: We are seeking a compassionate and dedicated individual to fill the r...
  • 3/25/2024 12:00:00 AM

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Dental Subspecialist
  • Kaiser Permanente
  • Oakland, CA
  • Description: Job Summary: Evaluates and treats TMJ disorders, Facial/Atypical Facial Pain, and oral pathology. Accuratel...
  • 3/25/2024 12:00:00 AM

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Adult Psychiatric Mental Health Nurse Practitioner - Remote
  • Foresight Mental Health
  • Oakland, CA
  • Welcome to Foresight Mental Health. Join a team with purpose! At Foresight Mental Health, we are committed to supporting...
  • 3/25/2024 12:00:00 AM

Hayward (/ˈheɪwərd/; formerly Haywards, Haywards Station, and Haywood) is a city located in Alameda County, California in the East Bay subregion of the San Francisco Bay Area. With a 2014 population of 149,392, Hayward is the sixth largest city in the Bay Area and the third largest in Alameda County. Hayward was ranked as the 37th most populous municipality in California. It is included in the San Francisco–Oakland–Fremont Metropolitan Statistical Area by the US Census. It is located primarily between Castro Valley and Union City, and lies at the eastern terminus of the San Mateo–Hayward Bridg...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$118,575 to $151,185
Hayward, California area prices
were up 4.5% from a year ago

Medical Claims Review Manager in Paramus, NJ
Support management with leading Medical Review team to ensure all types of claims requiring medical reviews are completed in compliance with State, Federal, accreditation standards and other applicable regulations.
February 01, 2020
Medical Claims Review Manager in Nashua, NH
By truly combining claims and bill review, the two systems are kept in sync utilizing the scheduled jobs of the aforementioned standard model; however, for real-time data updates, claims examiners are granted access to the entire live bill review system.
January 13, 2020
Medical Claims Review Manager in Davenport, IA
Complex claim errors can only be caught by physician reviewers with the clinical experience to spot mistakes that automated systems can’t detect.
January 03, 2020