Manager of Claims Processing

GuideWell; Irving (TX); On-site; USD 85,000 - 110,000; Full time

Job summary

WebTPA seeks a Manager of Claims Processing to drive business results through effective leadership and management processes, with emphasis on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits.

You will supervise Claims Assistant Managers, hire from within, coach AMCS teams, conduct 1:1s and appraisals, and work with HR on disciplinary actions, while serving as the primary client contact for daily items and updates.

Qualifications

• 4+ years related work experience in the claims administrative industry.
• 2+ years direct supervisory/management experience.
• Bachelor’s degree or additional related equivalent work experience.
• Strong verbal and written presentation/communication skills.
• Ability to handle confidential and sensitive information appropriately.
• Comfortable working across operational departments throughout the organization and in direct contact with clients.
• Microsoft Office skills are required, specifically Word, Excel, and Outlook.
• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.
• Strong time and project management skills.

Responsibilities

• Manages Claims Assistant Managers.
• Directly accountable for hiring and promoting from within WebTPA.
• Provides direction and coaching on performance of AMCS and their teams (direct and indirect reports).
• Conducts 1:1 meeting for updates and performance appraisals.
• Issues disciplinary measures in partnership with HR.
• Manage client relationships as primary contact for daily items, including weekly conference calls and monthly board meetings.
• Resolves claims issues by researching plan coverage, claims history, and educating customers and members through calls and written inquiries.
• Reports updates to the Sr. Manager Ops, and Director Ops.
• Works with plan sponsors, members, and coworkers to meet and exceed customer expectations.
• Direct contact with providers to resolve contract and payment issues.
• Monitors Client Performance Guarantees.
• Internal reports indicating claims log, success factors behind metrics with suggested proposals based on feedback from client and analysis.
• Reviews team performance metrics in conjunction with client satisfaction and advises on improvements and training.
• Partners with HR Talent Development for training initiatives.

Skills

Leadership

Supervisory experience

Communication

Confidential information handling

Time management

Project management

Client relationships

Cross-functional collaboration

MS Office (Word/Excel/Outlook)

Education

Bachelor's degree or related equivalent experience

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

AMCS system

CPT coding knowledge

Job description

What is your impact?

The Manager of Claims Processing is accountable for achieving business results through the application of effective leadership and management processes with a special emphasis and focus on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits.

What Will You Be Doing:

Supervisory responsibilities:

• Manages Claims Assistant Managers


• Directly accountable for hiring and promoting from within WebTPA.


• Provides direction and coaching on performance of AMCS and their teams (direct and indirect reports).


• Conducts 1:1 meeting for updates and performance appraisals.


• Issues disciplinary measures in partnership with HR.

Primary contact for clients on day-to-day items and updates:

• Manage client relationships as primary contact for daily items, including weekly conference calls and monthly board meetings


• Resolves claims issues by researching plan coverage, claims history, and routinely educating customers and members through a wide variety of calls and written inquiries.


• Reports updates to the Sr. Manager Ops, and Director Ops.


• Works in partnership with plan sponsors, members, and coworkers to meet and exceed customer expectations and requirements of the organization.


• Direct contact with providers to resolve contract and payment issues.


• Monitors Client Performance Guarantees


• Responsible for internal reports indicating claims log, success factors behind metrics with suggested proposals based on feedback from client and analysis.


• Consistently reviews team performance metrics in conjunction with client satisfaction and advises on areas for improvement and additional training necessary to be successful.


• Partners with HR Talent Development for training initiatives on team specific to performance metrics and internal reporting and internal audits.

Qualifications:

• 4+ years related work experience in the claims administrative industry


• 2+ years direct supervisory/management experience


• Related Bachelor’s degree or additional related equivalent work experience


• Strong verbal and written presentation/communication skills.


• Ability to handle confidential and sensitive information appropriately.


• Comfortable working across operational departments throughout the organization and in direct contact with clients.


• Microsoft Office skills are required, specifically Word, Excel, and Outlook.


• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.


• Strong time and project management skills.

Preferred Qualifications:

• Minimum of 2 years WebTPA specific claims processing experience preferred.

General Physical Demands:

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.


• Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities:

• Must be able to travel to multiple locations for work (i.e., travel to attend meetings, events, conferences). Occasionally