Manager, Claims Operations

🕒 6 days ago

🇺🇸 United States – Remote

💵 $70k - $85k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

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Allied Benefit Systems

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1980

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Allied Benefit Systems is a national healthcare solutions company that provides health plan administration, care and cost management, provider network services, and data analytics to employers, members, and benefits consultants. The company focuses on reducing healthcare costs, optimizing plan performance, and improving member experience through administrative services, analytics & insights, and customizable provider networks.

📋 Description

• Manage day-to-day operations of the Claims Appeals, Claims Medical Review, and Subrogation Teams • Monitor team metrics and operations • Implement best practices based on company goals • Identify strategic opportunities through financial analysis, projections, and cost/benefit analysis • Provide support, guidance, leadership, and motivation • Prepare reporting and analysis according to defined standards and processes • Provide technical guidance on claim investigation, reserving evaluation, and claim resolution • Partner with the analytical team to produce results and trending reports for leadership • Review high-dollar appeals, medical review referrals, and subrogation cases • Manage claims production operations and interact with parties involved in claims • Collaborate with Claims and business leaders on enterprise initiatives • Prepare files for subrogation • Oversee individual and unit performance against productivity and quality goals • Lead, coach, motivate, and develop employees • Conduct one-on-one meetings and performance appraisals • Provide training, resources, expectations, and constructive performance feedback • Attract and develop new talent • Perform other duties as assigned

🎯 Requirements

• Bachelor’s degree or equivalent work experience required • At least 5 years of TPA or group health insurance experience • At least 3 years at a supervisor level • Successfully demonstrated leadership competencies • In-depth knowledge of Claims, Benefits, and administrative skills and processes • Intermediate-level experience with Microsoft Office, Word, Excel, Access, and PowerPoint • Ability to easily learn other software and systems • Ability to write business correspondence and procedures • Internet service through cable broadband or fiber optic provider with at least 100 Mbps download/25 Mbps upload • Extended sitting and computer work required

🏖️ Benefits

• Medical Insurance • Dental Insurance • Vision Insurance • Life Insurance • Disability Insurance • Generous Paid Time Off • Tuition Reimbursement • Employee Assistance Program (EAP) • Technology Stipend • Flexible remote work from home

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