Manager Claim Processing

Description:

Hybrid Opportunity

Position Summary

The organization is seeking a results-driven leader to oversee the day-to-day operations of its claims processing team. This role is responsible for providing strategic direction, managing workflows, and ensuring the accurate and timely processing of medical claims. The ideal candidate will focus on establishing performance metrics, driving process improvements, and fostering cross-functional collaboration to enhance operational efficiency and customer satisfaction.

Key Responsibilities

• Oversee and manage daily operations of the claims processing department to ensure timely and accurate claim handling.
  
• Develop, implement, and maintain quality control standards to ensure accuracy, compliance, and consistency in claims adjudication.
  
• Provide guidance and support to team members on complex and escalated claims issues, ensuring adherence to policy and regulatory standards.
  
• Analyze key performance indicators (KPIs) to evaluate productivity and quality; prepare and present performance reports to senior leadership.
  
• Collaborate with cross-functional teams to identify and implement process enhancements, including automation and system upgrades.
  
• Ensure ongoing compliance with applicable laws, regulations, and industry best practices related to claims processing.
  
• Assist in budget planning by monitoring department expenses, analyzing variances, and recommending cost-effective strategies.
  
• Foster a positive and inclusive team culture that supports professional growth and accountability.
  
• Assign tasks and manage workload distribution to maximize team efficiency and ensure a balanced workload
• .

Requirements:

Required Qualifications

• 3–5 years of leadership or management experience
  
• Proficiency in Microsoft Word, Excel, and Office Suite
  
• Strong team collaboration and communication skills
  
• Ability to plan, execute, and deliver operational goals
  
• Proven problem-solving and sound decision-making capabilities
  
• Growth mindset with a focus on adaptability, personal development, and mentoring others