Claims Manager

🕒 Outubro 28

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $74.260 - $145.250 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 0%

O que significa: a chance de ninguém estar realmente contratando para esta vaga.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Por que essa pontuação:

• Aberta há 14 dias.
• As vagas desta empresa costumam ser preenchidas em 22 dias.

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Avēsis

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1978

🛡️ Seguros

⚕️ Seguro de Saúde

🧘 Bem-estar

Insurance • Healthcare Insurance • Wellness

Avēsis é uma empresa dedicada a fornecer benefícios especializados abrangentes, focados em melhorar o acesso, a equidade e os resultados de saúde. Especializada em planos odontológicos e de visão, Avēsis oferece benefícios odontológicos flexíveis, acessíveis e focados em resultados, além de planos de visão que conectam a saúde ocular ao bem-estar geral. Com mais de 40 anos de experiência, Avēsis está comprometida com o cuidado personalizado e a construção de redes de saúde comunitárias para atender parceiros governamentais, prestadores comerciais, empregadores e corretores. Avēsis opera como uma subsidiária integral da Guardian e utiliza soluções de rede e produtos personalizadas para oferecer cuidados de qualidade acessíveis aos membros, enquanto também administra programas de benefícios essenciais como Medicaid, Medicare e outros.

Descrição

• Provide direct oversight of Claims Supervisors, processing staff, claims processing workflows, queue management and daily transactional operations • Oversee timely and accurate claims processing within contractual and regulatory time frames • Interview, select and hire applicants for Claims department positions • Manage employee performance, set goals, oversee workloads, and monitor productivity, metrics and quality • Monitor claims inventory and address areas of concern with Claims Supervisors • Plan and assign employee job requirements and develop team goals and objectives • Ensure quality and productivity standards are monitored and feedback is provided • Resolve aged claims and manage claims adjustment projects • Present claims processing reviews, policy updates, audit findings and related communications in team meetings • Identify opportunities and oversee implementation of operational improvement plans • Support internal and external audit activity • Maintain departmental workflows, standard operating procedures and employee performance review processes • Communicate with internal stakeholders regarding pending or open deliverables • Present data, analysis and solutions concerning processing trends, improvement opportunities, concerns, turnaround times and quality benchmarks to the Claims Executive Leadership Team • Perform other duties as assigned

🎯 Requisitos

• Bachelor's degree or equivalent combination of education and experience • Minimum 5 years supervisory or management experience leading a production team • Minimum 3+ years’ experience leading or participating in development of claim enhancements, including auto-adjudication triggers, robotic process automation and claims adjudication system logic • Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level claims payment processes • Advanced proficiency in Microsoft Office products, including Excel, Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend and report recommendations • Ability to work flexible hours to accommodate business needs in all time zones • Excellent listening and verbal and written communication skills • Exposure/experience to CPT, HCPC, dental and diagnosis coding • Knowledge of general claims processing principles • Strong attention to detail and accuracy • Strong organizational skills with ability to manage multiple tasks and meet deadlines • Reliable internet service; 50 Mbps download and 10 Mbps upload while hardwired and not on a VPN are sufficient • Master's degree in a related field preferred • Experience within Dental/Vision insurance or healthcare organizations preferred

🏖️ Benefícios

• Competitive compensation package • Medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period • Life and disability insurance • 401(k) with company match • Tuition assistance • Paid parental leave • Backup family care • Flexible time off • Flexible dress code and work location policies • Employee Resource Groups • Social responsibility and community volunteering opportunities • Meaningful and challenging work opportunities • Dynamic, modern work environments that promote collaboration and creativity

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