Manager of Claims

Location: San Antonio, TX
Date Posted: 03-08-2018
Manager of Claims – Managed Care
San Antonio, TX
Manager of Claims Job Summary:
  • The Claims Team Manager plans, directs, coordinates and executes all claims inventory management activities in support of Self-Funded Health Insurance line of business.
  • Monitors claim volumes and activity to ensure 99% of all claims are processed within 30 days; 90% processed within 14 business days. Evaluate and take necessary action to ensure goals are met.
  • Develops, analyzes, and reports on high dollar claim, appeal, and adjustment inventories to ensure DOL compliance.
  • Design and implement organizational and departmental-wide policies and procedures that support continuous process improvement.
  • Develop and maintain reports that track productivity and quality results for claims processors
  • Maintain a 99% Financial, 98% Payment, and 97% Procedural accuracy, and meet and exceed established goals for performance guarantee clients.
  • Resolve escalated Client or Customer Service issues. Works with Account Management to provide support for Client/ Group related issues. Participates on Client calls when necessary.
  • Manages all personnel related duties including, but not limited to, interviewing and hiring new employees, counseling employees on performance or attendance issues, ensuring proper staffing levels are maintained, and provide initial and on-going training as needed.
  • Participate in the budget process and manage unit costs within budgetary guidelines.
  • Establishes and maintains necessary vendor relationships with strategic partners of the firm.
Manager of Claims Background: 
  • Bachelor’s degree in a related field, or the equivalent combination of related education and supervisory experience.
  • Demonstrated knowledge of claims adjudication systems and processes; knowledge of the GBAS claims system strongly preferred.
  • Experience in developing and implementing corporate policies and procedures.
  • Knowledge of Microsoft Office Applications (Word/ Excel/ Outlook) is required.
  • Ability to focus and execute collaboratively across all layers of the organization.
  • 5 plus years of previous supervisory experience in claims and / or customer service.
    Must be organized and detail-oriented.
  • Strong leadership and interpersonal skills with the ability to lead by example.
  • Excellent written and oral communication skills required.
  • Able to multi task effectively to meet goals, while being flexible to adjust to changes in priorities.
  • Must be team –oriented with a positive attitude.

Associate Search Consultant
CareNational Healthcare Services
480.448.6498 (CALL – TEXT – FAX)
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