Manager of Claims Processing

Florida Blue; Irving (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

Florida Blue is seeking a Manager of Claims Processing to lead the claims operations, focusing on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits. The role requires directing teams, coaching staff, and partnering with HR to drive performance.

You will manage Claims Assistant Managers, hire and promote from within WebTPA, conduct 1:1 updates and appraisals, resolve issues with providers and plans, maintain client relationships through weekly calls and

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 and with clients.
• Microsoft Office skills: Word, Excel, and Outlook.
• Experience with CPT coding and related procedural reviews is a plus.
• Strong time and project management skills.

Responsibilities

• Oversee supervisors and managers of claims processing teams.
• Hire and promote from within WebTPA.
• Provide direction and coaching on performance of AMCS and teams.
• Conduct 1:1 meetings for updates and performance appraisals.
• Issue disciplinary measures in partnership with HR.
• Manage client relationships as primary contact for daily items and updates.
• Resolve claims issues by researching plan coverage and history.
• Report updates to Sr. Manager Ops and Director Ops.
• Partner with plan sponsors, members, and coworkers to meet customer expectations.
• Direct contact with providers to resolve contract and payment issues.
• Monitor Client Performance Guarantees and performance metrics.
• Advise on improvements and training needs based on metrics and feedback.
• Collaborate with HR Talent Development on training initiatives.

Skills

Verbal communication

Written communication

Leadership

Time management

Project management

Performance coaching

Education

Bachelor's degree or equivalent

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