Job Description

What is your impact?

The Manager of Claims Processing is accountable for achieving business results through the application of effective leadership and management processes with a special emphasis and focus on reviewing procedures for new clients, Summary Plan Documents, and clarifying plan benefits.

What Will You Be Doing:

Supervisory responsibilities:

• Manages Claims Assistant Managers
• Directly accountable for hiring and promoting from within WebTPA.
• Provides direction and coaching on performance of AMCS and their teams (direct and indirect reports).
• Conducts 1:1 meeting for updates and performance appraisals.
• Issues disciplinary measures in partnership with HR.

Primary contact for clients on day-to-day items and updates:

• Manage client relationships as primary contact for daily items, including weekly conference calls and monthly board meetings
• Resolves claims issues by researching plan coverage, claims history, and routinely educating customers and members through a wide variety of calls and written inquiries.
• Reports updates to the Sr. Manager Ops, and Director Ops.
• Works in partnership with plan sponsors, members, and coworkers to meet and exceed customer expectations and requirements of the organization.
• Direct contact with providers to resolve contract and payment issues.
• Monitors Client Performance Guarantees
• Responsible for internal reports indicating claims log, success factors behind metrics with suggested proposals based on feedback from client and analysis.
• Consistently reviews team performance metrics in conjunction with client satisfaction and advises on areas for improvement and additional training necessary to be successful.
• Partners with HR Talent Development for training initiatives on team specific to performance metrics and internal reporting and internal audits.

Qualifications:

• 4+ years related work experience in the claims administrative industry
• 2+ years direct supervisory/management experience
• Related Bachelor’s degree or additional related equivalent work experience
• Strong verbal and written presentation/communication skills.
• Ability to handle confidential and sensitive information appropriately.
• Comfortable working across operational departments throughout the organization and in direct contact with clients.
• Microsoft Office skills are required, specifically Word, Excel, and Outlook.
• Customized programs for medical CPT coding, review of multiple surgical procedures, and establishment of reasonable and customary fees.
• Strong time and project management skills.

Preferred Qualifications:

• Minimum of 2 years WebTPA specific claims processing experience preferred.

General Physical Demands:

• Sedentary work: Exerting up to 10 pounds of force occasionally to move objects.
• Jobs are sedentary if traversing activities are required only occasionally.

Physical/Environmental Activities:

• Must be able to travel to multiple locations for work (i.e., travel to attend meetings, events, conferences). Occasionally