Remote Claims Manager - Lead Process & Care Excellence

Avēsis; United States; Remote; USD 74.000 - 145.000; Vollzeit

Zusammenfassung

Avēsis seeks a Manager of Claims to lead a remote claims team nationwide. You will oversee Supervisors, guide processing workflows, and ensure timely, accurate claim payments while aligning with contracts and quality standards.

You will present data-driven insights to leadership, implement improvement plans, and collaborate across departments to enhance outcomes for members and providers. The role offers a strong opportunity for leadership and impact.

Qualifikationen

• Bachelor's degree or equivalent combination of education and experience.
• Minimum 5 years supervisory or management experience leading a production/claims team.
• Minimum 3+ years' experience leading or participating in claim enhancements, including auto-adjudication triggers and robotic process automation.
• Knowledge of Medicare, Medicaid, and/or Commercial insurance terminology and high-level claims 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).

Aufgaben

• Direct oversight of Claims Supervisors and claims support staff, processing workflows, and performance reviews.
• Demonstrate knowledge of contracts, performance requirements, and payment processes.
• Ensure timely and accurate processing of claims within contractual timeframes.
• Interview, select and hire applicants for Claims department positions.
• Manage employee performance, goals, workloads, and quality metrics.
• Monitor claims inventory and assist supervisors to address concerns.
• Develop goals and objectives for supervised staff and ensure quality and productivity standards.
• Present data and insights to leadership on processing trends and improvement opportunities.
• Support audits and annual workflow reviews and SOP maintenance.
• Communicate timely with internal stakeholders regarding pending deliverables.

Kenntnisse

Leadership

Communication

Problem solving

Attention to detail

Time management

Ausbildung

Bachelor's degree or equivalent

Tools

Microsoft Excel

Microsoft Word

Adobe Acrobat

Jobbeschreibung

Avēsis seeks a Manager of Claims to lead a remote claims team nationwide. You will oversee Supervisors, guide processing workflows, and ensure timely, accurate claim payments while aligning with contracts and quality standards.

You will present data-driven insights to leadership, implement improvement plans, and collaborate across departments to enhance outcomes for members and providers. The role offers a strong opportunity for leadership and impact.