Claims Manager

Job not on LinkedIn

🔥 1 minute ago

🇺🇸 United States – Remote

💵 $74.3k - $145.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 0%

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Avēsis

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1978

🛡️ Insurance

⚕️ Healthcare Insurance

🧘 Wellness

Insurance • Healthcare Insurance • Wellness

Avēsis is a company dedicated to providing comprehensive specialty benefits focused on improving access, equity, and health outcomes. Specializing in dental and vision plans, Avēsis offers flexible, affordable, and outcome-focused oral health benefits as well as vision plans that connect eye health to overall well-being. With over 40 years of experience, Avēsis is committed to personalized care and building community health networks to service government partners, commercial providers, employers, and brokers. Avēsis operates as a wholly owned subsidiary of Guardian, and leverages tailored network and product solutions to deliver accessible quality care to members, while also administering Medicaid, Medicare, and other essential benefits programs.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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