Regional Claims Manager jobs in Wichita Falls, TX
Regional Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Regional Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Regional Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to top management. The Regional Claims Manager typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. To be a Regional Claims Manager typically requires 3+ years of managerial experience. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. (Copyright 2024 Salary.com)
Recently Added Regional Claims Manager jobs
Case Manager
- United Regional Health Care System
-
Wichita Falls, TX
FULL_TIME
-
Summary of Essential Functions:
-
Encompasses the process of case management practice in partnership with the medical staff and members of the clinical team accountable for outcomes of selected patient populations.
-
Accountable to the patient and the community and is responsible for facilitating the patient’s safe, cost efficient, progression-of-care throughout the entire episode of acute care and assuring the patient’s timely and seamless transition back to the community.
Educational Requirements:-
High School diploma or equivalent
-
Associate degree or Bachelor’s Degree in Nursing
-
Must be able to communicate effectively in English, both verbally and in writing.
Licenses and Certifications:-
Registered Nurse with current Texas license and in good standing with governing board in Texas
-
Nationally recognized certification in Case Management preferred.
-
Current certification in Basic Life Support (BLS) preferred.
-
Current CPI training preferred.
Knowledge/Skills/Abilities:-
At least 5 years recent hospital experience and knowledge of CMSA’s case management standards of practice.
-
High degree of interpersonal and communication skills
-
Vocal, visual, auditory, physical, and manual ability to adequately perform clinical psychosocial interventions.
-
Must have basic computer knowledge including word processing and navigational skills
-
Must be able to demonstrate the ability to work effectively as a healthcare team member and prioritize work.
-
Ability to demonstrate proficiency in use and application of all electronic tools
-
Must have effective written and verbal communication skills, be a positive relationship builder, ability to effect change, perform critical analysis, plan and organize effectively.
Duties and Responsibilities:-
Advocate for patient by assessing that patient healthcare needs are being addressed at the most appropriate level of care. Assesses patient situation by collecting information from patient and family, professional and non-professional caregivers, employers (as appropriate), and health records to identify individual needs to develop a comprehensive progression-of-care management plan that will address those needs.
-
Communicates, consults and coordinates with medical advisor as necessary to resolve progression-of-care barriers through appropriate administrative and medical channels. Serve as primary liaison between clinical team. Maintain appropriate documentation on each patient to include specific information of all planning, liaison, and coordination activities. Educates members of the patient’s healthcare team on the appropriate access to, and use of various levels of care. Recognizes and responds appropriately to risk factors. Assess the effectiveness of services and their outcomes in concert with the interdisciplinary team, recommending appropriate plan modifications to assure treatment objectives are met.
-
Pro-actively participate as a member of the interdisciplinary clinical team to confirm appropriateness of the treatment plan relative to the patient’s preference, reason for admission, and availability of resources. Actively participate in daily rounding meetings, patient care conferences, and hospitalist/nurses hand-off reports to gather sufficient information to determine the effectiveness of the treatment plan and patient care goals. Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes. Understand and apply federal law regarding the use of HINNs, ABNs, and medical necessity criteria. Assertively collaborate and manage resource utilization while appropriately navigating the patient's movement along the continuum of care.
-
Collaborate with nursing and members of the clinical team to provide patient/family education regarding discharge goals that require the team’s expertise (medication administration, transferring to/from a car, oxygen use, etc). Research discharge placement options, when home discharge is not possible, while continuing to focus on patient/family goals, interdisciplinary team recommendations, available payer benefits and private financial considerations which may impact placement.
-
Communicates and coordinates with Utilization Review Nurses (URN) for correct bed status confirmation and medical necessity for continued stay. Work closely with URN to identify and assist with trend determination of outlier cases. Facilitate and ensure appropriate clinical documentation for level of services and acuity of care accurately reflected in the medical record.
-
Assure discharge plan is addressed during daily rounds, keeping patient/family objectives in mind while modifying the plan as appropriate. Update all involved parties regarding progress, revisions and other information related to the discharge plan. Demonstrates mature negotiation and conflict management strategies and skills. Coordinate post -acute needs and assure seamless hand-offs to the most appropriate community provider
-
Uses interpersonal skills which convey a positive and supportive attitude and is straightforward and tactful in language (e.g.: active listening, good communication, telephone etiquette). Demonstrate knowledge of current regulatory and accrediting agency requirements as it pertains to obtaining services for patients. Demonstrates flexibility in response to unexpected changes in work volume, emergency staffing, and scheduling. Participate in follow-up processes to discharged patients to query about quality and timeliness of post-acute arrangements.
-
Searches for and takes advantage of leadership opportunities to enhance own professional growth. Maintains self-direction and demonstrates ability to resolve issues pro-actively. Maintains current working knowledge through review of national organizations via list serves, meetings, newsletters and journals. Consistently attends meetings.
-
Preserve the basic human rights of expression, decision, action and personal dignity for all patients and families. Respect the cultural diversity of all patients, families and employees of United Regional Health Care System.
-
Performs all other tasks/responsibilities as necessary.
-
- 14 Days Ago
URPG Care Plus Manager
- United Regional Health Care System
-
Wichita Falls, TX
FULL_TIME
- Summary of Essential Functions Responsible and accountable for the operations management and performance of the assigned practice(s). Manages all provider and non-provider staff, which includes but is...
- 25 Days Ago
EHR Implementation - Training Manager
- United Regional Health Care System
-
Wichita Falls, TX
FULL_TIME
- Summary of Essential Functions: Responsible for communicating training Epic training policies and procedures across the organization and for overall coordination of training activities and trainers. R...
- 27 Days Ago
Claims Examiner
- Partnered Staffing - Kelly Services
-
Wichita Falls, TX
FULL_TIME
- Company DescriptionAt Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talen...
- 1 Month Ago
Claims Technician
- Partnered Staffing - Kelly Services
-
Wichita Falls, TX
FULL_TIME
- Company DescriptionAt Kelly Services, we work with the best. Our clients include 99 of the Fortune 100 TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best tale...
- 1 Month Ago
Insurance Claims Examiner
- Partnered Staffing - Kelly Services
-
Wichita Falls, TX
FULL_TIME
- Company DescriptionAt Kelly Services, we work with the best. Our clients include 99 of the Fortune 100TM companies, and more than 70,000 hiring managers rely on Kelly annually to access the best talen...
- 1 Month Ago
Filters
- Current Active Filter
- Wichita Falls, TX
Clear All
- Filter Jobs By posted time
- Within 1 Day
- Within 2-7
- Within 1 Month
- Within 3 Months
0 Regional Claims Manager jobs found in Wichita Falls, TX area
CURRICULUM & EDUCATION TECHNOLOGY SPECIALIST
- Air Education and Training Command
-
Sheppard Afb, TX
- Summary Click on "Learn more about this agency" button below to view Eligibilities being considered and other IMPORTANT ...
- 4/20/2024 12:00:00 AM
Senior Software Engineer, Full Stack
- Capital One
-
Wichita Falls, TX
- Plano 7 (31067), United States of America, Plano, Texas Senior Software Engineer, Full Stack Do you love building and pi...
- 4/20/2024 12:00:00 AM
Senior Software Engineer, Back End (Python)
- Capital One
-
Wichita Falls, TX
- Plano 1 (31061), United States of America, Plano, Texas Senior Software Engineer, Back End (Python) Do you love building...
- 4/20/2024 12:00:00 AM
Senior Software Engineer, Back End
- Capital One
-
Wichita Falls, TX
- Plano 6 (31066), United States of America, Plano, Texas Senior Software Engineer, Back End Do you love building and pion...
- 4/20/2024 12:00:00 AM
Senior Data Engineer
- Capital One
-
Wichita Falls, TX
- Plano Town Center (31064), United States of America, Plano, Texas Senior Data Engineer Do you love building and pioneeri...
- 4/20/2024 12:00:00 AM
UNIT PROGRAM COORDINATOR
- Air Education and Training Command
-
Sheppard Afb, TX
- Summary Click on "Learn more about this agency" button below to view Eligibilities being considered and other IMPORTANT ...
- 4/19/2024 12:00:00 AM
Claims Specialist
- Kelly Services
-
Wichita Falls, TX
- Job Description Job Description What’s next for you? This great job. Finding a job that fits your lifestyle isn’t always...
- 4/17/2024 12:00:00 AM
Wholesale Insurance Sales Manager
- Grow Tech Indemnity LLC
-
Wichita Falls, TX
- Job Description Job Description We are seeking a Wholesale Insurance Sales Manager to join our team! You will be respons...
- 4/17/2024 12:00:00 AM
About Wichita Falls, Texas
Wichita Falls (/ˈwɪtʃɪtɑː/ WITCH-i-taw) is a city in and the county seat of Wichita County, Texas, United States. It is the principal city of the Wichita Falls Metropolitan Statistical Area, which encompasses all of Archer, Clay, and Wichita Counties. According to the 2010 census, it had a population of 104,553, making it the 38th-most populous city in Texas. In addition, its central business district is 5 miles (8 km) from Sheppard Air Force Base, which is home to the Air Force's largest technical training wing and the Euro-NATO Joint Jet Pilot Training program, the world's only multinationa...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Regional Claims Manager jobs
$144,782 to $202,772
Wichita Falls, Texas area prices
were up 1.2% from a year ago
were up 1.2% from a year ago
What does a Regional Claims Manager do?
Regional Claims Manager in Tucson, AZ
As a Regional Contract Claims Manager, located in our Broomfield, CO office, you will have responsibility for claims management within your assigned region.
December 13, 2019
Regional Claims Manager in Las Cruces, NM
Paul Martin of Colorado seek an unspecified amount of damages against defendants Shelly Reams, former administrator of the Wyoming Aeronautics Commission; members of the Cheyenne Regional Airport Board; Dave Haring, manager of the Cheyenne airport; and Great Lakes Aviation.
February 18, 2020
Regional Claims Manager in Passaic, NJ
Aligning performance of regional teams, to support delivery of the wider Third-Party Claims Targets & Objectives.
January 16, 2020