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)
```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:
Schedule:
Supplemental pay types:
Ability to Relocate:
Work Location: Hybrid remote in Dublin, CA 94568
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