Claims Manager

🕒 Maio 22

🌵 Arizona – Remoto

🌵 Arizona – Remote

⏰ Tempo Integral

🟠 Sênior

🔴 Especialista

👔 Gerente

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amps

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2005

⚕️ Seguro de Saúde

💳 Fintech

🤝 B2B

Healthcare Insurance • Fintech • B2B

A AMPS é líder na redução de custos de saúde para organizações autofinanciadas, dedicada a transformar como as empresas gerenciam suas despesas com saúde. Com quase duas décadas de experiência, a AMPS oferece soluções inovadoras e centradas no membro, como PriceDynamix, ClaimInsight e Drexi, que geram economia, mantendo a alta qualidade dos cuidados. Sua abordagem personalizada capacita as organizações a controlarem seus custos de saúde sem comprometer o bem-estar dos membros, tornando-a um parceiro confiável na obtenção de economias sustentáveis em saúde.

Descrição

• Maintain HIPAA/PII guidelines to ensure the confidentiality of all calls and documents • Serve as a liaison between departments, vendors and clients to ensure collaborative progress • Exhibit strong working knowledge of customer business operations • Demonstrate strategic business acumen in decisions affecting bottom line focus • Generate and deliver accurate and timely reports • Assist with troubleshooting for technical issues • Serve as a role model in demonstrating core values of customer service • Encourage continuous learning, personal development and accountability through team members • Provide timely and thorough responses to internal and external customers • Respond to member and group correspondences regarding plan/guideline or claim questions within 24 hours • Escalate difficult issues to the appropriate channels • Assist in the processing and resolution of escalated issues • Ensure team compliance with service standards • Follow trends within assigned scope and alert appropriate parties of any trends that fall outside quality parameters • Develop and execute plans to meet established goals • Provide continuous feedback to strengthen and optimize quality performance • Work cross-departmentally to improve or streamline procedures • Maintain up to date knowledge on industry trends and look for new data sources • Develop new and improve current internal processes to improve overall quality • Conduct regular performance evaluations of employees and provide ongoing feedback and coaching as necessary • Address and counsel employees on behavioral or performance problems and implement corrective action as necessary • Explain and administer company policies required for team members to perform duties successfully • Distribute and monitor departmental workloads to ensure adequate coverage while meeting quality and service levels • Oversee new and ongoing training and update training manuals • Coordinate and actively participate in departmental meetings

🎯 Requisitos

• College degree or equivalent required • Degree in Medical Billing and Coding or related field preferred • Knowledge of medical terminology preferred • 7 -10 years Claims Examiner experience or equivalent required • 4 -7 years management experience required

🏖️ Benefícios

• Health insurance • 401(k) matching • Paid time off • Flexible work arrangements • Professional development opportunities