Claims Manager (Days)

At-a-Glance :

Are you ready to build your career by joining a healthcare provider? If so, our client is hiring a Claims Manager (Days)!

What You’ll Do :

• Supervise and mentor a team of claim processors, adjusters, auditors, and appeal coordinators.
• Conduct performance evaluations and provide training and coaching when necessary.
• Foster a positive and productive work environment with the ability to motivate and guide team members, resolve conflicts, and address performance issues in a constructive manner.
• Oversee the processing of health insurance claims and appeals to ensure accuracy and adherence to company policies and procedures, as well as state and federal regulations.
• Review and audit high dollar and complex claims and resolve escalated issues.
• Monitor claim trends, utilizing data to target and implement process improvements to enhance efficiencies and reduce errors.
• Stay updated on changes in health insurance laws and regulations to ensure ongoing compliance.
• Work closely with the Care Team to ensure routed service tickets and escalations are handled timely and with a high level of satisfaction, addressing and resolving customer complaints.
• Prepare, track, and analyze reports on claim performance, including but not limited to daily inventory; monitoring metrics related to processing times, accuracy, financial impact, etc.
• Collaborate with other departments to integrate best practices and enhance overall operational efficiency.
• Maintain and report on staffing analytics.
• Other duties as assigned.

What You’ll Bring :

• Minimum of + years of experience in health insurance claims management, with a preference of + years of health insurance experience.
• Strong understanding of health insurance claims processing, procedures, and regulatory requirements.
• Excellent leadership and interpersonal skills with a proven track record of effective communication and relationship-building with team members, stakeholders, and clients.
• Strong analytical and problem-solving abilities.
• Ability to work both independently and within a team as a contributor and leader in a fast-paced, changing environment.
• Bonus Points : Experienced with technical software and ability to work with IT dept to ensure systems talk properly. Experience working for a startup.

Understanding of electronic claim exchanges and network routing. Bachelor's degree, or equivalent work experience.

COVID Vaccination.

Position Type : Contract to Hire

Get in Touch :

We want to hear from you! If you think you’d be a good match, submit your resume and reach out to Lalit at to learn more.

Who We Are :

Since , Hired by Matrix, Inc. has improved our candidates' lives with exciting job opportunities that provide outstanding career advancement.

Hired by Matrix offers our contract professionals competitive salaries, benefits after days, and a k option with a company match after one year.