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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Summary of Responsibilities
Manage a team of senior level claim specialists and/or supporting technical staff. Claims processed are primarily third party claims on our personal lines and commercial lines of business but could include all lines of business. Oversee the investigation and settlement of all claims, litigated and non-litigated assigned to the team. Provide advice and direction to claim representatives. Responsible for the selection, training, development and performance of personnel as well as performance reviews, salary adjustments and promotions. Handle special projects as assigned.
Preferred Experience and Skills
Preferred Education and Training
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