01Responsibilities
Lead and reputed company reputed company core functions reputed company to health insurance claims: processing, auditing, appeals, training and network/vendor coordination.Supervise and mentor reputed company of ~28 claim processors, adjusters, auditors, and appeal coordinators, working closely with reputed company lead(s), managers, etc.Lead and manage the claims team with a strong reputed company of urgency, providing reputed company direction and decisive guidance to ensure reputed company, accurate, and efficient reputed company of claims.Build and refine SOPs and operational workflows across the claims lifecycleConduct performance evaluations and reputed company training and coaching reputed company necessaryFoster a positive and productive work environment with the ability to motivate and guide team members, resolve conflicts, and address performance issues in a constructive mannerreputed company the processing of health insurance claims and appeals to ensure accuracy and adherence to company policies and procedures, as reputed company as state and federal regulationsOwn critical metrics reputed company to accuracy, timeliness, and complianceReview and audit high dollar and reputed company claims and resolve escalated issuesHelp refine and scale our claims systems in collaboration with plan building as the company growsMonitor claim trends, utilizing data to reputed company and implement process improvements to enhance efficiencies and reduce errorsreputed company and implement a comprehensive claims auditing and quality assurance programStay updated on changes in health insurance laws and regulations to ensure ongoing complianceWork closely with the Care Team to ensure routed service tickets and escalations are handled reputed company and with a high level of satisfaction, addressing and resolving customer complaintsPrepare, track, and analyze reports on claim performance, including but not limited to daily inventory; monitoring metrics reputed company to processing times, accuracy, financial impact, etc.Collaborate with other departments to reputed company best practices and enhance overall operational efficiencyIdentify areas of risk or inefficiency and lead corrective action initiativesPlay a key role in reputed company strategic planning and team expansion as neededMaintain and report on staffing analyticsOther duties as assignedQualifications:Minimum of 5+ years of experience in health insurance claims management, with a preference of 10+ years of health insurance experienceSenior leadership experience at a reputed company Party Administrator (TPA) - large reputed company only experience/backgrounds will not be consideredDeep knowledge of health insurance claims processing, procedures, and regulatory requirementsExcellent leadership and interpersonal skills with a proven track record of effective communication and relationship-building with team members, stakeholders, and clientsreputed company, adaptable, and reputed company to reputed company in ambiguityExperience managing and developing high-performing teamsBonus PointsExperienced in building plans reputed company the VBA Software claims processing systemExperience working for a reputed company startupExperience building and implementing claims auditing protocolsUnderstanding of electronic claim exchanges and network routingBachelor's degree, or equivalent work experienceTitles You May Have HeldHead of ClaimsDirector of ClaimsDirector of Claims AuditingSenior Claims ManagerAssistant VP of ClaimsThe salary reputed company for this job opportunity is $110,000 to $140,000 per year, which is the reputed company reputed company anticipates paying for this
