Manager, Claims Processing

Allied Benefit Systems; United States; A distancia; USD 90.000 - 130.000; Jornada completa

Descripción de la vacante

Allied Benefit Systems seeks a Manager of Claims Processing to lead teams ensuring accurate and timely claim processing in alignment with client SLAs, plan provisions, and regulatory standards. The role drives performance across inventories, networks, and multiple products, focusing on service excellence and audit readiness.

Responsibilities include coaching staff, managing escalations, and collaborating with stakeholders to improve workflows and member experience.

Formación

• Bachelor's degree or equivalent work experience required.
• Minimum 5 years of medical claims analysis and adjudication experience, including dental and vision.

Responsabilidades

• Lead teams to ensure claims processing aligns with SLAs, plan documents, and regulatory standards.
• Monitor inventory, productivity, and quality to ensure timely, accurate claims handling.
• Oversee networks, products, and client performance requirements with focus on service excellence and audit readiness.
• Coach and develop staff; conduct performance reviews and talent development.
• Collaborate with stakeholders to resolve escalated client issues and streamline workflows.

Conocimientos

Leadership

Claims analysis

Communication

Time management

Problem solving

Coaching

Cross-functional collaboration

Educación

Bachelor's degree

Herramientas

Claims Management Systems

Descripción del empleo

POSITION SUMMARY

The Manager of Claims Processing will lead teams responsible for ensuring that claims are processed according to network and client Service Level Agreements and in accordance with Plan Documents, Regulatory standards, and established policies and procedures. The Manager of Claims Processing is responsible for management of all claim inventories and leading teams in a fast paced, high growth environment that demands strong decision making, adaptability, and effective cross functional coordination. Additionally, this position will support strategies and enhancements that are implemented to improve the claims process and enhance member experience.

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ESSENTIAL FUNCTIONS

• Monitor inventory, productivity, and quality reports for all books of business to ensure that all claims are handled timely and accurately
• Lead initiatives to manage/reduce inventory levels through data driven analysis, forecasting improvements, and innovative problem solving
• Oversee key networks, products, and individual client performance requirements with a focus on service excellence, performance compliance, and audit requirements
• Manage elevated authority claim reviews to ensure appropriate handling; release claims accurately and timely in conjunction with dollar authority limit set for Manager role
• Provide comprehensive support for new clients and products across all books of business
• Collaborate with internal stakeholders to resolve, address escalated client/broker issues, and streamline workflows for better efficiency and accuracy
• Attend outside audits as needed to ensure accurate reporting
• Develop and implement strategies that align with the company’s overall goals and objectives.
• Attend continuing education classes as required, including but not limited to HIPAA training.
• Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent.
• Clearly communicate expectations , provide employees with the training, resources, and information needed to succeed.
• Actively engage, coach, counsel and provide timely, and constructive performance feedback.
• Other duties as assigned

EDUCATION

• Bachelor's degree or equivalent work experience required.

EXPERIENCE AND SKILLS

• A minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) required
• A minimum of years’ experience at a supervisor level with demonstrated leadership competencies.
• Demonstrated understanding of Claims Management systems and platforms
• Strong analytical and technical claims expertise across relevant lines of business, CPT, HCPCS, and ICD-10 coding, Coordination of Benefits (COB), and medical terminology
• Excellent written and verbal communication skills
• Exceptional time management skills and ability to prioritize work
• Strong problem solving and conflict resolution skills and ability to handle sensitive client escalations

POSITION COMPETENCIES

• Accountability
• Coaching and Feedback
• Collaboration
• Customer Focus
• Decision Making