Note: The job is a remote job and is open to candidates in USA. Allied Benefit Systems is seeking a Manager, Claims Operations to oversee the Claims Processing department. The role involves managing a team to ensure accurate and efficient claims processing while developing strategies to enhance the claims process and member experience.

Responsibilities

• Work with Human Resources to interview, select, hire, and onboard an appropriate number of employees
• Coach, mentor, and develop staff, including training/overseeing new employees
• Empower employees to take responsibility for their jobs and goals. Delegate responsibility and expect accountability and regular feedback
• Lead employees using a performance management and development process that provides an overall context and framework to encourage employee contribution and includes goal setting, feedback, and performance development planning
• Develop and implement strategies that align with the company’s overall goals and objectives
• Provide comprehensive support for new business across all books of business
• Collaborate with other departments to streamline workflows for better efficiency and accuracy
• Monitor all reports for all books of business to ensure that all claims are handled timely and accurately
• Lead, coach, motivate and develop. Responsible for one-on-one meetings, performance appraisals, growth opportunities and attracting new talent
• Clearly communicate expectations, provide employees with the training, resources, and information needed to succeed
• Actively engage, coach, counsel and provide timely, and constructive performance feedback
• Attend outside audits as needed to ensure accurate reporting
• Attend continuing education classes as required, including but not limited to HIPAA training
• Adhere to, and apply all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto
• Other duties as assigned

Skills

• Bachelor's Degree or equivalent work experience required
• A minimum of 5 years of medical claims analysis and adjudication experience (including dental and vision claims analysis) required
• A minimum of 5 years' experience at a manager level with successfully demonstrated leadership competencies is required
• All applicants must have strong analytical skills and knowledge of computer systems and CPT and ICD-9 coding terminology
• Excellent written and verbal communication skills
• Exceptional time management skills and ability to prioritize work

Benefits

• Remote

Company Overview