Claims Manager / Supervisor

• Hire and facilitate training of the Claims Associates staff and provide direct supervision to employees.
• Perform employee evaluations and reviews annually or as needed.
• Oversee Claims call center and ensure phone coverage is available at all times during business hours.
• Audit claims, member calls, and documentation for accuracy and compliance with company policies and PHI/HIPAA regulations.
• Develop, implement, maintain and/or improve department procedures and manuals.
• Maintain department’s consistent production of both daily claims processing and daily tasks including: document requests, logs, specialty programs, online portal assistance, and system updates.
• Review and research uncommon claim processing issues and provide resolutions.
• Provide team guidance to identify claim overpayments, request refunds, and monitor process for claims staff.
• Efficiently complete Claims department procedures for client on-boarding or off-boarding.
• Understand and be able to process claims based upon contractual and/or Client agreements, involving the use of established payment methodologies, applicable regulatory legislation, policies and claims procedures guidelines.
• Review issues that impact production and quality, i.e. incorrect database configurations, non-compliant claims, inefficient processes, system interface issues, etc.

• Must have strong, demonstrated management skills.
• Must be proficient and experienced with ICD-10 coding.
• Manage time and prioritize effectively while demonstrating the ability to handle complex issues and constant change.
• Quality-focused performance.
• Must be well organized, able to multi-task while remaining detail oriented.
• Must be proficient working with database and processing software, excel, word and outlook.
• Must have good mathematical, problem solving and analytical skills.
• Provide the best customer service to all customers (external and internal) using professional written and verbal skills.
• Develop and maintain effective working relationships with peers, subordinates, management and customers.
• Flexibility and ambition to learn new skills in a fast-paced environment when change is the constant.
• Knowledge of WLT claims processing system a plus!

Express Employment Professionals