Manager of Claims Processing

WebTPA Employer Services, LLC; Irving (TX); On-site; USD 85,000 - 105,000; Full time

Job summary

WebTPA Employer Services, LLC is seeking a Manager of Claims Processing to lead teams and optimize procedures for new clients, Summary Plan Documents, and clarifying plan benefits. You will drive performance through coaching, reporting, and collaboration with HR and clients.

You will supervise Claims Assistant Managers, manage client relationships, resolve claims issues, and partner with plan sponsors to meet customer expectations while maintaining internal reporting and audits.

Qualifications

• 4+ years related work experience in the claims administrative industry.
• 2+ years direct supervisory/management experience.
• Related Bachelor's degree or equivalent work experience.
• Strong verbal and written presentation/communication skills.
• Ability to handle confidential and sensitive information appropriately.
• Comfortable working across operational departments and with clients.
• MS Office skills: Word, Excel, Outlook.
• CPT coding knowledge and experience with medical procedures and fees.

Responsibilities

• Supervisory responsibilities: Manages Claims Assistant Managers and hires/promotes from within WebTPA.
• Directs performance coaching on AMCS teams and conducts 1:1 updates.
• Issues disciplinary measures in partnership with HR.
• Manages client relationships as primary contact for daily items and maintains weekly conference calls and monthly board meetings.
• Resolves claims issues by researching coverage, history, and educating customers.
• Reports updates to Sr. Manager Ops and Director Ops.
• Partners with plan sponsors, members, and coworkers to meet/customer expectations; resolves contract/payment issues.
• Monitors performance metrics and proposes improvements and training.
• Collaborates with HR Talent Development on training and internal audits.

Skills

Leadership

People management

Client relationship management

Communication skills

MS Office

CPT coding

Time management

Education

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

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