Manager, Claims Operations

🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – 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 operational functions of the Claims Appeals, Claims Medical Review, and Subrogation Teams • Monitor metrics and operations within these teams • 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 consistent with 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 day-to-day claims production operations • Interact with parties involved in the claim process • Collaborate with Claims and business leaders on enterprise initiatives • Assist with or prepare files for subrogation • Oversee individual and unit performance against productivity and quality goals and metrics • Lead, coach, motivate, and develop employees • Conduct one-on-one meetings and performance appraisals • Provide training, resources, expectations, coaching, counseling, and timely constructive feedback • 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 work 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 connection through a cable broadband or fiber optic internet service provider • Internet speeds of at least 100Mbps download/25Mbps upload

🏖️ Benefits

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