Claims Manager

🕒 Outubro 29

🗽 New York – Remoto

🗽 New York – Remote

💵 $95.000 - $100.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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Esta empresa já patrocinou vistos H1B no passado.

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• Aberta há 13 dias.
• As vagas desta empresa costumam ser preenchidas em 63 dias.

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Centivo

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2017

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

A Centivo é uma inovadora fornecedora de planos de saúde para empregadores auto-segurados que foca em entregar cuidados de saúde de alta qualidade a um custo acessível. A empresa acredita no poder do atendimento primário para melhorar os resultados de saúde e reduzir custos. A Centivo oferece planos com atendimento primário gratuito, sem franquias e co-pagamentos baixos e previsíveis, incentivando, assim, os membros a utilizarem seus benefícios de saúde sem sobrecarga financeira. Os planos são elaborados para atender a rigorosos padrões de preço e qualidade, promovendo um forte relacionamento com os provedores de atendimento primário e integrando opções de atendimento virtual. A abordagem da Centivo é projetada para reduzir as despesas médicas gerais, ao mesmo tempo em que melhora a experiência de saúde tanto para empregadores quanto para empregados.

Descrição

• Oversee and manage health claims processing for self-funded employer groups • Directly manage claim supervisors, subject matter experts, and Claims Analysts • Set and monitor productivity goals and claims quality metrics • Manage cross-functional dependencies affecting backlog and turnaround-time goals • Collaborate with Quality/Training and System Configuration teams to establish standard processes and mitigate issues • Support client relationships and implementation processes • Serve as a point of contact for clients, vendors, or providers when required • Establish and monitor metrics for claims processing and payment according to benefit plans, pricing agreements, and authorizations • Manage claims inventory against standard service level agreements • Educate and mentor claims staff; establish performance plans and provide coaching • Report claim inventory, production, turnaround lag, and quality metrics to department leaders • Create work plans to reduce claims inventory and monitor overtime for cost effectiveness • Develop and monitor policies and procedures for benefit-plan and claims administration • Foster employee morale, teamwork, goal setting, and professional growth • Establish annual staff goals and provide timely, constructive performance feedback • Liaise on claims-related projects, initiatives, testing, system implementations, and upgrades • Potentially manage vendors and network partners, vendor invoices, overpayment and recovery, subrogation, appeals, pricing strategies, and process improvement • Perform other essential duties

🎯 Requisitos

• Proficient experience in MS Word, Excel, Outlook, and PowerPoint • Understanding of health insurance benefit administration in a self-funded environment • Strong leadership and team management skills • Ability to communicate effectively with others • Demonstrated ability with process development, process improvement, and change management • Ability to read and understand various forms, documentation, files, and information within the department • Excellent verbal and written communication skills • Ability to communicate complex or technical information clearly and concisely • Strong interpersonal skills • At least 5 years of experience with self-funded health care plans • Experience in a Third Party Administrator (TPA) environment • Prior experience with a highly automated and integrated claim adjudication system • Salesforce experience is a plus • El Dorado-Javelina experience preferred but not required • Experience with Health Rules Payer and/or El Dorado-Javelina preferred • Advanced proficiency in Excel preferred • Experience managing claims inventory preferred • Must be authorized to work in the United States for any employer • Centivo does not sponsor work authorization visas

🏖️ Benefícios

• Equity option grants • Bonus • Health benefits, some employer paid • Paid time off (PTO) • Ability to work from home for remote candidates • Free primary care (including virtual), predictable copay and no-deductible benefit plan design for Centivo-covered employees

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