Manager of Claims

Avesis Incorporated; Texas; Hybride; USD 74 000 - 145 000; Plein temps

Avantages offerts par ce poste

Competitive compensation

Excellent medical, dental, vision

401(k) with company match

Tuition assistance

Paid parental leave

Flexible time off

Résumé du poste

Avesis Incorporated in the United States is seeking a Manager of Claims to oversee Claims Supervisors and processing staff, driving timely, accurate claim handling and operational excellence across our vision and dental benefits platform.

The role emphasizes workflow leadership, performance management, and collaboration with executives to improve accuracy, turnaround times, and customer satisfaction while ensuring compliance with contract and regulatory requirements.

Qualifications

• Bachelor's degree or equivalent required; supervisory/management experience preferred.
• Minimum 5 years in supervisory or management roles leading a production/claims team.
• 3+ years in development of claim enhancements, auto-adjudication triggers, or RPA in claims systems.
• Knowledge of Medicare, Medicaid, or Commercial insurance terminology and claim payment processes.
• Proficiency in MS Office and data analysis; ability to work across time zones.

Responsabilités

• Oversee Claims Supervisors and staff; manage workflows and performance reviews.
• Ensure timely, accurate claims processing per contracts and regulatory requirements.
• Hire and develop staff; monitor productivity and quality metrics.
• Present data and improvement plans to Claims leadership; drive process improvements.
• Assist in audit activities and update SOPs and policies.

Connaissances

Leadership

Claims processing

Data analysis

Workflow management

Communication

Formation

Bachelor's degree or equivalent

Master’s degree preferred

Outils

Microsoft Office

Excel

Claims software

Description du poste

Join us for an exciting career with the leading provider of supplemental benefits! Our Promise Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards. As the Manager of Claims at Avesis you will help create communities and systems of care that supports everyone having access to quality healthcare and services while being treated with dignity.

With over 40 years’ experience managing commercial and government-sponsored benefit programs, we are one of the leading vision and dental insurance services companies in the nation, with an extensive network of providers. We provide essential vision, dental benefits to small and large businesses, municipalities, government agencies, and major medical providers and ensure members receive necessary dental and vision services to support overall health.

The Claims operations team at Avesis is responsible for timely and accurately processing all claims. This is the team's continual commitment to ensure provider payments are accurate and member benefits are maximized. We have a proven track record for processing clean claims within 30 calendar days or less, reducing provider abrasion and increasing member satisfaction.

Job Summary

The Manager of Claims is responsible for direct oversight of Claims Supervisors, processing staff and claims technology initiatives. The Manager is responsible for upholding and administering all claims processing functions and will participate and lead in the development and performance of the Claims Processing team and ensuring high quality and timely outcomes. This includes work-flow oversight, assessment of error reduction initiatives, consistent execution of claim payment procedures, completion of special projects, overseeing supervisor team performance. This individual will present relevant data, analysis and solutions related to feedback regarding identified processing trends, process improvement opportunities, general areas of concern found in routine review activity, claims processing turnaround times and quality benchmarks to the claims Executive Leadership Team.

Functional

Ensure direct oversight of Claims Supervisors and claims support staff, claims processing workflows, queue management and daily transactional operations and completion and delivery of annual performance reviews. Demonstrate knowledge and understand contracts and performance requirements, claims processing workflow, automated process implantation and payment process. Oversight of timely and accurate processing of claims as required by contractual and regulated time frames. Interview, select and hire applicants for various Claims department positions. Manage employee performance, set goals, oversee workloads, monitor productivity/metrics and quality. Monitor claims inventory and assist claims supervisors to proactively address areas of concern. Assist in monitoring, planning, and assigning employee job requirements. Development of specific goals and objectives for supervised team members. Ensure quality and productivity standards are being monitored and feedback is being provided to frontline staff. Assist management and processors in resolving aged claims or handling of claims adjustment projects. Presenting topics and attendance in team meetings related to claims processing reviews and updates for company policies and procedures, audit findings, and other related communications. Identify opportunities to develop and oversee implementation of improvement plans for best operations and outcomes. Support audit activity including both internal and external audit activity when needed. Participate in annual review and maintenance of departmental workflow, Standard operating procedures, and employee performance review activity. Communicate timely with internal Avesis stakeholders regarding pending or open deliverables. Perform other duties occasionally as assigned.

Core

Exposure/experience to CPT, HCPC, Dental and diagnosis coding. Knowledge of general claims processing principles. Ability to pivot between competing priorities and execute responsibilities within tight deadlines. Strong attention to detail and accuracy. Strong organizational skills with the ability to manage multiple tasks and meet deadlines. Strong communication skills, both verbal and written.

Behavioral

Collegiality: building strong relationships on company-wide, approachable, and helpful, ability to mentor and support team growth. Initiative: readiness to lead or take action to achieve goals. Communicative: ability to relay issues, concepts, and ideas to others easily orally and in writing. Member-focused: going above and beyond to make our members feel seen, valued, and appreciated. Detail-oriented and thorough: managing and completing details of assignments without too much oversight. Flexible and responsive: managing new demands, changes, and situations. Critical Thinking: effectively troubleshoot complex issues, problem solve and multi-task. Integrity & responsibility: acting with a clear sense of ownership for actions, decisions and to keep information confidential when required. Collaborative: ability to represent your own interests while being fair to those representing other or competing ideas in search of a workable solution for all parties.

Minimum Qualifications

• Bachelor's degree or equivalent combination of education and experience
• Minimum 5 years supervisory or management experience leaving leading a production team.
• Minimum 3+ years’ experience leading or participating in the development of claim enhancements, including auto-adjudication triggers; robotic process automation and claims adjudication system logic.
• Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level clams' payment processes.
• Advanced in Microsoft Office products, including Excel, Word, Adobe, and other Windows-based tools used to aggregate, analyze, trend and report recommendations for increased operational performance.
• Ability to work flexible hours to accommodate business needs in all time zones.
• Excellent listening, communication (verbal and written).

Preferred Qualifications

• Master’s degree in a related field, will consider experience in lieu of degree.
• Experience within Dental/Vision insurance or healthcare organizations.

Pay Ranges

Base pay within the range is ultimately determined by a candidate's skills, expertise, or experience. In the United States, we have three geographic pay zones. For this role, our current pay ranges for new hires in each zone are:

• Zone A: $74,260.00-$123,760.00
• Zone B: $80,940.00-$134,900.00
• Zone C: $87,150.00-$145,250.00

FLSA Status: Salary/Exempt

This role may also be eligible for benefits, bonuses, and commission. Please visit Avesis Pay Zones for more information on which locations are included in each of our geographic pay zones. However, please confirm the zone for your specific location with your recruiter.

Benefits

We Offer Meaningful and challenging work opportunities to accelerate innovation in a secure and compliant way.

• Competitive compensation package.
• Excellent medical, dental, supplemental health, life and vision coverage for you and your dependents with no wait period.
• Life and disability insurance.
• A great 401(k) with company match.
• Tuition assistance, paid parental leave and backup family care.
• Dynamic, modern work environments that promote collaboration and creativity to develop and empower talent.
• Flexible time off, dress code, and work location policies to balance your work and life in the ways that suit you best.
• Employee Resource Groups that advocate for inclusion and diversity in all that we do.
• Social responsibility in all aspects of our work.
• We volunteer within our local communities, create educational alliances with colleges, drive a variety of initiatives in sustainability.

Equal Employment Opportunity At Avēsis, We See You

We celebrate differences and are building a culture of inclusivity and diversity. We are proud to be an Equal Employment Opportunity employer that considers all qualified applicants and does not discriminate against any person based on ancestry, age, citizenship, color, creed, disability, familial status, gender, gender expression, gender identity, marital status, military or veteran status, national origin, race, religion, sexual orientation, or any other characteristic.

At Avēsis, we believe that, to operate at the peak of excellence, our workforce needs to represent a rich mixture of diverse people, all focused on providing a world-class experience for our clients.

We focus on recruiting, training and retaining those individuals that share similar goals.

Come Dare to be Different at Avēsis, where We See You!

Avēsis has been providing essential ancillary benefit solutions since 1978. Since its inception Avēsis has developed, administered and refined its offerings to provide clients with best-in-class product choices and services. Today, our programs cover more than 8.5 million members throughout the country. We strive for excellence in all that we do and our benchmark performance in terms of member satisfaction and client retention underscores this singular focus.