Hybrid Claims Operations Manager — Colorado

Communityplans; Denver (CO); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Paid time off

Parental leave

Retirement plans

Healthcare benefits

Tuition assistance

Loan forgiveness eligibility

Job summary

Denver Health is seeking a mission-driven Manager, Claims – Denver Health Medical Plan, to lead the claims processing function in Colorado. This hybrid role requires in-office presence three days per week in Denver and must reside in Colorado.

You will train analysts, ensure timely and accurate adjudication, and drive process improvements within Managed Care Administration. The role emphasizes coordination of benefits, system upgrades, policy updates, and collaboration with internal teams to

Qualifications

• Five years of health care claims experience required.
• Two years of lead or supervisory experience required.
• Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules.
• Knowledge of NAIC coordination of benefit rules.
• Excellent verbal and written communication skills.
• Demonstration of good supervisory skills.
• Knowledge of general report writing.
• Ability to work independently and collaboratively, generate creative ideas for interventions with other internal and external team members to ensure timelines are met.

Responsibilities

• Oversees the day-to-day operations within the DHMP Claims Department and the vendor Claims Department.
• Ensures optimal performance in claims quality, claims financial accuracy, and compliance with State and Federal Regulations.
• Manages claims analyst to resolve claims issues related to authorization issues, provider issues, claim edits, and claim audits.
• Manages proactive and retrospective claims review to ensure accuracy and identify system/processing issues.
• Assists with system upgrade efforts.
• Recommends, reviews and modifies all necessary policies and procedures within the department.
• Prioritize work volumes on a daily basis.
• Drives change initiatives to address future-oriented business needs.

Skills

Claims processing

Supervisory experience

Communication skills

Microsoft Suite

Tools

Microsoft Office

Job description

Denver Health is seeking a mission-driven Manager, Claims – Denver Health Medical Plan, to lead the claims processing function in Colorado. This hybrid role requires in-office presence three days per week in Denver and must reside in Colorado.

You will train analysts, ensure timely and accurate adjudication, and drive process improvements within Managed Care Administration. The role emphasizes coordination of benefits, system upgrades, policy updates, and collaboration with internal teams to