Claims Manager

Job Category:Third Party Administration Primary Location:USA-VA: VIRGINIA-RICHMONDSchedule:Full-time Job Type:Standard Employee Status:Regular No Job Posting: 2008-09-09Description: Essential Job Functions Plans, develops and supervises the administration of routine to moderately complex claims programs to ensure proper claims policies, practices and procedures. Oversees and approves small to medium sized billing statements, claims, and associated administrative activities to ensure compliance with laws, regulations, policies, agreements, and contractual arrangements. Plans and implements procedures to adjust claims when original demographic, sponsor, or charge information is in error; monitors and controls resubmission of denials, rejections, and appeals. Intercedes with third parties in unusual situations involving payment or adjustment of charges on accounts; consults with departments concerning services which affect collection of charges. Coordinates and prepares periodic reports on department activities, including productivity, cash collections, status of accounts receivable, unbilled accounts, allowances, adjustments, related functions, audits, and financial reporting. Assists with the development and implementation of policies and procedures consistent with those of the organization to ensure efficient and safe operation of the unit. Selects and hires employees. Trains and evaluates employees to enhance their performance, development, and work product. Addresses performance issues and makes recommendations for personnel actions. Motivates and rewards employees including providing salary increases, bonuses and promotions within allocated budgets and company guidelines. Prepares and recommends operating and personnel budgets for approval. Monitors spending for adherence to budget, recommends variances as necessary. Basic Qualifications Bachelor's degree or equivalent combination of education and experience Bachelor's degree in business administration, insurance or related field preferred Nine or more years of claims experience Five or more years of leadership experience included Experience working with proper claims handling, policies, and procedures Experience working with computer based analysis tools Experience working with applicable laws, regulations and practices regarding the insurance industry Experience working with insurance and/or medical terminology Other Qualifications Manage day-to-day operations of inbound and outbound claims processing functions in accordance with client Service Level Agreements; Ensure that all operational components are performed in accordance with approved contract requirements; Ensure that cooperative relationships exist in a customer environment and work cooperatively with a state-run operations group; Ensure that all request jobs are run as approved by client; Manage claims processing staff to meet clients requests, including ad hoc reporting, special batch requests and other needs as they arise; Report and resolve production and environment issues timely and accurately; and Report Operational metrics associated with Service Level Agreements to client on a weekly basis. Demonstrated experience managing people, developing teams, and meeting contractual requirements; Demonstrated ability to communicate effectively, orally and in writing with all levels of management; Five or more years claims processing experience; Demonstrated ability to simultaneously manage concurrent projects and effectively respond to unanticipated client business needs; Demonstrated ability to manage staff in a diverse and highly stressful environment; and Demonstrated experience with superior customer service skills. Good organization skills to balance and prioritize work Good analytical and problem solving skills Good communication skills Good human relations skills to select, develop, mentor, discipline and reward employees Good negotiation skills to interact with claimant Ability and willingness to seek out and maintain knowledge of the industry Ability to work independently and lead group activities Remote Work Location Authorized:No Relocation Assistance:Not AvailableClearance Level:None Create Success