MSLA - Claim Manager - Independent Medical Exams & Qualified Medical Exams - Cypress, CA

MSLA is a Medical Corporation that provides comprehensive independent medical evaluations (IME) and other IME related services to the government and private industry. Our business philosophy incorporates both exceptional customer service and quality evaluations, both of which are the primary factors for our rapid growth since our inception in 1998. No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)
 
This position is responsible for the general operational oversight of the IME and QME department. The Claim Manager will work with key members of the business team and executives to ensure that day-to-day business objectives are met and client expectations are exceeded.  The manager will support our existing IME, Peer Review and other services while helping the company to expand our portfolio of services to meet industry needs. The manager will also have responsibility for business growth and bottom line financial results.
 
Primary Responsibilities:

Responsible for overall production, performance and quality of the IME Business
Provide leadership and directly supervise team members to ensure performance expectations and milestones are achieved
Work as a point of contact to effectively understand the unique client needs; Manage new client onboarding process; Interacts with clients to strengthen/expand existing relationships and to ensure appropriate and timely resolution of service issues; Recommends solutions for meeting these needs through process mapping analysis, resource allocation, and division of labor
Identify potential new clients and new lines of business; participate in prospective and current client meetings
Work with business leaders and technology team to improve process and system support
Sets team direction, resolves problems and provides guidance to the team members
Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
Conduct regular self-audits of department results, processes and workflows. Analyze the information to improve outcomes and maximize productivity
Identify opportunities and implement process improvements to optimize outcomes and mitigate costs;
Accountable for maintaining effective internal controls over the processes and transactions;
Adapts departmental plans and standard operating procedures to address business needs;
Influence and/or provides input into forecasting and planning activities;
Responsible for managing doctor utilization to ensure they are meeting contractual expectations and timelines
Assist on RFP’s
Lead and/or participate in workgroups and committees
Perform other duties as assigned or required by operational need, or as assigned by Management
Competencies:

Demonstrated ability to lead and motivate others
Demonstrated ability to work independently, and in conjunction with team members at all levels of the organization
Ability to work in a high volume environment with emphasis on accuracy and timeliness
Demonstrated ability to think strategically, and execute operationally and tactically
Able to process mapping and evaluate metrics to continuously improve results
Able to understand instructions furnished in written, oral, diagram, or schedule form
Excellent verbal and written communication skills
Critical thinker, solution driven and self-motivated
Organized, detail oriented,  and articulate
Proficient in general computer use and Microsoft Office Suite

Required Qualifications:

Operations Management with specific IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME)
Bachelor’s Degree in Business Administration or Healthcare Administration or equivalent work experience
Knowledge and understanding of Claim Processes and Workflows
3+ years of experience in managing employees
Strong Business and Operations Leader
Preferred Requirements:

Experience /Knowledge of Peer Reviews
3rd Party Administrator or Insurance Company experience
Medical Disability Exam Experience  
Knowledge of relevant State and Federal Compliance Guidelines
Prior experience partnering with Sales to identify and on-board new clients
Careers with MSLA. Our focus is simple. We’re innovators at providing technology - driven, comprehensive, independent medical evaluations to government and private entities.  In addition to our core clinics located throughout California, Nevada and Hawaii, we manage an extensive nationwide network of fully credentialed physicians in all major specialties. We’ve joined Optum, part of the UnitedHealth Group family of businesses. And when you join our team, you’ll impact the lives of others by verifying the validity of claims, providing quality examinations and meeting the timelines that make a difference for our customers.  Here, you’ll join a team that makes you want to do better every day, resulting in your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
 
 
Job Keywords: claims, claim manager, medical exams, Cypress, California, CA