Assistant Manager jobs in United States

The Assistant Manager – Medical Claims is responsible for overseeing the day-to-day operations of the medical claims department, ensuring accurate, timely, and compliant processing of claims. The role involves supervising claims officers, monitoring performance, liaising with providers and stakeholders, and ensuring adherence to regulatory and company policies while driving efficiency and service excellence.

1. Claims Processing & Review

• Supervise and review medical claims to ensure accuracy, completeness, and compliance with policy terms, guidelines, and regulatory requirements.
• Authorize and approve claims within delegated authority limits.
• Support in resolving escalated or complex claims cases.

2. Team Management

• Lead, train, and mentor claims officers to ensure high-quality output and adherence to SLAs.
• Monitor workload distribution and staff productivity.
• Conduct regular performance reviews and provide feedback.

3. Compliance & Quality Assurance

• Ensure compliance with UAE Central Bank / DHA / HAAD / MOHAP regulations and internal audit requirements.
• Implement quality checks and controls to minimize errors and fraudulent claims.
• Maintain updated knowledge of medical policies, procedures, and regulatory changes.

4. Provider & Customer Relations

• Liaise with healthcare providers for claim clarifications, negotiations, and dispute resolution.
• Support customer service teams in handling escalated queries related to claims.
• Build and maintain strong relationships with stakeholders to ensure smooth operations.

5. Reporting & Analysis

• Prepare periodic MIS reports on claim trends, turnaround times, and team performance.
• Analyze claims data to identify cost drivers, patterns of fraud, or areas for efficiency improvement.
• Provide insights and recommendations to management for policy or process enhancements.

6. Process Improvement & Projects

• Assist in developing and implementing claims policies, workflows, and system enhancements.
• Participate in projects aimed at digital transformation, automation, and operational excellence.
• Ensure continuous improvement in turnaround times, accuracy, and customer satisfaction.