Medical Claims Review Manager jobs in South Dakota

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 Process Optimization Manager
  • Safety National
  • Date, SD FULL_TIME
  • Stop searching. Start growing. It’s time to build a meaningful career where you can grow, your ideas can thrive, and you are recognized and valued. Join a team committed to your excellence, and apply to Safety National today!

    Ready for a rewarding career? Follow this link to view all of our available careers and apply: https://www.safetynational.com/careers-page/

    This opportunity is in the Claims Department.

    Our Claims department oversees both high-exposure workers’ compensation and liability claims. As an unbundled carrier, we work actively with third-party administrators (TPAs) and self-administered accounts to assist in guiding claims to a successful resolution. As an excess carrier, the catastrophic claims we handle keep our group challenged, but the uniqueness provides plenty of growth opportunities.

    Role Description:

    In the role of Claims Process Optimization Manager you will be responsible for optimizing Liability claim processes focused on improving operational efficiencies, quality and service by analyzing existing workflows, identifying areas of improvement, establishing role clarity and implementing changes through collaborative work and within a defined decision-making process.

    Your day-to-day responsibilities as a Claims Process Optimization Manager will include:

    • Proactively identifying opportunities to remove obstacles and to improve operational effectiveness through efficiencies, member experiences and processes
    • Monitoring and measuring the progress of the team against the tactical plan for process efficiency and compliance
    • Evaluating current claim systems, assisting with enhancements and exploring the need for new systems
    • Coordinating best practices, drafting of standards and process improvement initiatives
    • Building an enhanced Quality Program for Liability Claims inclusive of Third Party Administrator (TPA) Performance
    • Meeting established service levels and recommend additional metrics to measure performance and efficiency
    • Identifying risks associated with business activities and ensuring results are measured, monitored and controlled

    The ideal candidate is someone who has:

    • The ability to streamline processes, coordinate across different departments and collaborate with cross-functional teams and subject matter experts throughout the Company
    • Excellent interpersonal skills to build quality relationships
    • Ability to effectuate change by working with and gaining input from stakeholders
    • Advanced level of analytical skills, experience using and interpreting data to communicate results

    Qualifications:

    Education:

    • Bachelor’s degree from accredited college or university required

    Required:

    • 10 years’ experience with Liability Claim Handling, Operations and Quality Oversight
    • Candidate must be a motivated, self-starter with the ability to work independently
    • Strong written and oral communication skills
    • Efficient, analytical, thorough, observant and detail-oriented
    • Advanced skills in general Windows based technology systems, including Microsoft Office products

    Preferred:

    • 5 years’ leadership experience within Liability Claims Operations preferred

    If this role describes you, apply today!

    Safety National is a leading specialty insurance and reinsurance provider. Our culture is built upon relationships, which allow us to demonstrate our expertise gained through our rich 80-year history. As a wholly-owned subsidiary of Tokio Marine, Inc., we appreciate the benefits and support provided by our affiliation with one of the top 10 insurance companies in the world.

    A Benefits Structure That Puts Employees First

    Safety National’s approach to benefits reaches far beyond competitive fixed compensation. Instead, we construct a total rewards benefits package for each valued member of our team. Highlights include incentive award bonuses, an annual holiday bonus, and profit-sharing contributions. Other exceptional benefits include generous healthcare coverage, a 401(k) match, enhanced paid caregiver leave, and family-forming benefits for adoption, surrogacy, and fertility. We also promote balance by offering a hybrid working environment and several employee appreciation events throughout the year. Apply today to learn more about our total rewards approach.

  • 8 Days Ago

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RN Peer Review Specialist - Medical Staff - Sioux Falls
  • Sanford Health
  • Sioux Falls, SD FULL_TIME
  • Create Your Career With Us! Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportuni...
  • 15 Days Ago

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Customer Support Representative - Technical
  • Quality Claims Solutions
  • Sioux Falls, SD FULL_TIME
  • Responsible for analyzing, troubleshooting and evaluating technology issues. This role may support internal clients, helping to keep employees productive, or external customers of a company, helping t...
  • 2 Days Ago

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MSP Manager
  • Wapiti Medical
  • Huron, SD FULL_TIME
  • OPEN POSITION - MUST WORK PRIMARILY WITHIN 150 MILES OF OUR HURON OR MILBANK, SD OFFICES. Wapiti is currently seeking a MSP Coordinator. This is a full-time position Monday-Friday with some periodic a...
  • 2 Days Ago

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English Document Review Attorney
  • Contact Government Services, LLC
  • Pierre, SD CONTRACTOR
  • English Document Reviewer Contact Review - Washington, DC Location: Remote Start Date: Negotiable EXPERIENCE & QUALIFICATIONS: Familiarity with document review workflows Examples: Privilege/Responsive...
  • 3 Days Ago

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Travel Registered Nurse RN Case Manager
  • OneStaff Medical
  • RAPID CITY, SD FULL_TIME
  • We. Are. OneStaff. Medical. An independently - owned, nationally - recognized and amazingly awesome staffing firm ready to work for you! A work ethic forged in the Midwest, we are here to stand by you...
  • 1 Month Ago

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Orem, UT
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Fairfield, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Folsom, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco Animal Supplies Inc
  • Saratoga Springs, NY
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/28/2024 12:00:00 AM

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Medical Lead - Oncology, Medical Affairs
  • SEC Life Sciences
  • One of the world's leading pharmaceutical companies is seeking four passionate, forward-thinking individuals for key rol...
  • 3/28/2024 12:00:00 AM

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Hospital Medical Leader
  • Petco
  • Menifee, CA
  • Create a healthier, brighter future for pets, pet parents and people! If you want to make a real difference, create an e...
  • 3/27/2024 12:00:00 AM

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Executive Director, Head of Medical Affairs, Immunology
  • RBW Consulting
  • Philadelphia, PA
  • A major international pharma business is looking to expands its immunology pipeline and requires a dynamic and forward t...
  • 3/25/2024 12:00:00 AM

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Head of Medical Writing
  • Morgan Prestwich - Life Science & Healthcare Executive Search
  • Company Overview Morgan Prestwich is thrilled to be representing our client on an exclusive basis. Our client is a clini...
  • 3/24/2024 12:00:00 AM

South Dakota (/- dəˈkoʊtə/ (listen)) is a U.S. state in the Midwestern region of the United States. It is named after the Lakota and Dakota Sioux Native American tribes, who compose a large portion of the population and historically dominated the territory. South Dakota is the seventeenth largest by area, but the fifth smallest by population and the 5th least densely populated of the 50 United States. As the southern part of the former Dakota Territory, South Dakota became a state on November 2, 1889, simultaneously with North Dakota. Pierre is the state capital and Sioux Falls, with a populat...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Medical Claims Review Manager jobs
$85,787 to $109,380

Medical Claims Review Manager in Parkersburg, WV
This end-to-end e-billing and e-payment solution is fully integrated with DecisionPoint, which means it can be immediately and easily integrated with your providers, adjusters, IT infrastructure, and claims workflow—enabling you to.
January 01, 2020
Medical Claims Review Manager in Juneau, AK
Examples include a claims examiner’s view of a particular bill’s status in a claim record’s related bill screen, or a bill review analyst’s view of an available reserve amount for the claim record related to the bill they are processing.
December 03, 2019
Medical Claims Review Manager in Galveston, TX
Assists the Manager, Medical Review with performing duties to oversee day-to-day activities within the Medical Claims Review Department to facilitate the achievement of business goals and targets.
December 16, 2019