Claims Operations Manager, Medicare/Medicaid MD,DC,VA (Remote)

Lensa; Fairfax (VA); Remote; USD 90,000 - 168,000; Full time

Job summary

A leading company in healthcare is seeking a Claims Operations Manager to oversee operations in Medicare/Medicaid. The role involves managing claims processing, customer service, and operational improvements. Candidates should have a Bachelor's degree and at least 5 years of relevant experience, including supervisory roles. This full-time position offers a competitive salary and comprehensive benefits.

Benefits

Comprehensive benefits package

401k contribution programs

Qualifications

• 5 years progressive experience in operations, including call center and claims.
• 1 year supervisory experience or demonstrated leadership.

Responsibilities

• Manages daily activities of operations, including claims processing and customer service.
• Achieves operational objectives by implementing strategies and monitoring performance.

Skills

Knowledge of call center operations

Strong presentation skills

Highly proficient in Microsoft Office

Excellent communication skills

Ability to plan and supervise

Education

Bachelor's Degree in Business or related field

Job description

Claims Operations Manager, Medicare/Medicaid MD,DC,VA (Remote)

Claims Operations Manager, Medicare/Medicaid MD,DC,VA (Remote)

1 day ago Be among the first 25 applicants

Get AI-powered advice on this job and more exclusive features.

Lensa is the leading career site for job seekers at every stage of their career. Our client, CareFirst BlueCross BlueShield, is seeking professionals. Apply via Lensa today!

Purpose

Resp & Qualifications

Manages the daily activities of a multi-functional operations area. Functional areas may include but not limited to: installation, implementation, client support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations. Investigates and settles claims or other customer service related issues not resolvable by lower staff members.

Essential Functions

• Achieves operational objectives by contributing information and analysis to strategic plans and reviews; preparing and completing action plans; implementing production, productivity, quality, customer-service standards; identifying and resolving problems; identifying, developing, and implementing system improvements. Meets departmental financial objectives by estimating requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
• Determines operations strategies by conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements.
• Manages employee outcomes by recruiting, selecting, orienting, training, assigning, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
• Develops call center, claims and or enrollment and billing systems by establishing technical specifications; developing customer interaction and voice response systems, and voice networks; designing user interfaces; developing and executing user acceptance test plans; planning and controlling implementations.
• Maintains and improves departmental operations by monitoring system performance; identifying and resolving operations problems; managing process improvement and quality assurance programs; installing upgrades.
• Prepares call center, claims and or enrollment and billing performance reports by collecting, analyzing, and summarizing data and trends.
• Improves call center, claims and or enrollment and billing and management job knowledge by attending educational workshops; reviewing professional and technical publications; establishing personal networks; benchmarking state-of-the-art practices.
  
  

Qualifications

Education Level: Bachelor's Degree, Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience : 5 years progressive experience in operations with time spent in a call center, claims, billing and enrollment, operations environment. 1 year supervisory experience or demonstrated progressive leadership.

Knowledge, Skills And Abilities (KSAs)

• Knowledge of call center operations claims and/or enrollment and billing and workflows.
• Strong presentation skills.
• Highly proficient in Microsoft Office programs.
• Excellent communication skills both written and verbal.
• Ability to plan, review, supervise, and inspect the work of others.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. Salary Range: $90,480 - $167,954
  
  

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Medicare/Medicaid Claims

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

REQNUMBER: 20828

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Management and Manufacturing

• Industries

  IT Services and IT Consulting

Referrals increase your chances of interviewing at Lensa by 2x

Get notified about new Claims Operations Manager jobs in Fairfax, VA.

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.