Manager, Claims

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

We are recruiting for a mission-driven Manager, Claims – Denver Health Medical Plan (Must Live in Colorado) to join our team!

We’re with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values:Respect | Belonging | Accountability | Transparency

Department:Managed Care Administration

Must Live in Colorado. Hybrid role with an in-office requirement of 3 days per week in Denver, Colorado

Job Summary

Maintains supervision of the day to day claims processing function for the Denver Health Medical Plan. Trains claims business analysts to ensure accurate processing of claims. Educates regarding subrogation and coordination of benefits. Reviews claims adjudication for timeliness and accuracy of payment. Educates claims business analysts regarding contract terms. Interfaces with other personnel within the Managed Care Division to assist with extraction of accurate claim information for reporting purposes. Interfaces with Managed Care Information Systems regarding system changes and data extraction.

Essential Functions

• Oversees the day-to-day operations within the DHMP Claims Department and the vendor Claims Department. (20%)
• Ensures optimal performance in claims quality, claims financial accuracy, and compliance with State and Federal Regulations. (10%)
• Manages claims analyst to resolve claims issues related to authorization issues, provider issues, claim edits, and claim audits. (10%)
• Manages proactive and retrospective claims review that are done on a continual basis to ensure accuracy and to identify system and/or processing issues. (10%)
• Assists with system upgrade efforts. (10%)
• Recommends, reviews and modifies all necessary policies and procedures within the department. (10%)
• Prioritize work volumes on a daily basis. (10%)
• Drives change initiatives to address future-oriented business needs. (10%)

Work Experience

• Five years of health care claims experience required and
• Two years of lead or supervisory experience required

Knowledge, Skills and Abilities:

• Fluent understanding of HCPC codes, UB 04 forms, HCFA 1500 forms, RBRVS fee schedules, and other common claim coding conventions.
• Understanding 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.
• Proficient in Microsoft Suite.

Shift

Days (United States of America)

Work Type

Regular

Benefits

At Denver Health, we take care of the people who take care of our community. Our benefits are built to support your life, your family, and your future — with generous paid time off, fully paid parental leave, exceptional retirement contributions, comprehensive health coverage, and nationally recognized well-being programs. We invest in your growth through tuition assistance, career advancement pathways, and professional development — while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health, you’re joining a mission-driven organization that invests in you.

Here Is a Small List Of Our Benefit Programs:

• Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
• 100% paid parental leave up to 6 weeks
• Immediate eligibility for retirement plans with employer contribution up to 9.5%
• Generous medical, dental, vision plans in addition to employer paid disability and life insurance.
• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
• Free RTD EcoPass (public transportation)
• Childcare discount programs & exclusive perks on large brands, travel, and more
• Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
• Professional clinical advancement program & shared governance
• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, the Public Health Institute at Denver Health, Denver Health Medical Plan and Denver Health Foundation.

As Colorado’s primary, and essential, safety-net health care system, Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.