Customer Service & Claims Manager

Reporting to the Manager, Managed Care Claims & Customer Service, this position is responsible for responding to all provider and patient inquiries in a courteous and efficient manner. As a delegated payer, Redlands community Hospital serves numerous customers and this requires telephonic accessibility as well as other forms of media. In addition, this position will support the organization by assisting with other administrative / clerical needs within the Department where applicable.

Reportingto the Director of Finance, this position is responsible for the overallmanagement of the Managed Care administration department including claimsprocessing, customer service, health plan reporting and audits, regulatorycompliance as well as the oversight of the Managed Care staff.

• Ability to meet all job & physical requirements as outlined in job description or as agreed through a work place accommodation

EDUCATION / TRAINING / EXPERIENCE :

1. Bachelor’s Degreein Business Administration, or Health Care Administration preferred.

2. Minimum fiveyears of experience in a management role with responsibilities for staffperforming claims processing, customer service and other managed careadministration duties including health plan reporting and audits.

3. Knowledge ofclaims processing software; EZCAP and Meditech preferred.

4. MedicalTerminology, CPT and ICD9-10 coding knowledge.

CERTIFICATIONS / LICENSES :

1. MAB is required to be completed on the first day ofwork. (Grandfathered : existing employees must complete new requirementsby 6 / 9 / 2025.)