Claims Manager

BASIC JOB PURPOSE:

The er is to oversee the daily

This position will e new program implementations and/or system implementations. This position must maintain an up-to date knowge of national and state-wide standards and s pertaining to

The position supervises all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-s.

S TO:

Director of Finance or Designee

TYPICAL WORKING CONDITIONS:

Office environment.

Responsibilities/Duties:

• Provide an environment that allows staff members to flourish in their work duties. Quality levels of 99% maintained throughout the department.
• Continuous training of staff on responsibilities as well as on all enhancements and updates to s and company ies.
• Develop changes to improve
• Maintain quality goals and production levels within the Department to ensure quality and production goals associated with each work area are consistently met by staff during their regularly schedu work hours.
• Create, maintain and monitor departmental documents including ies, s, desktop s, workflow documents and job aids to ensure these documents are current and meet the requirements of Call the Car.
• Track and trend the metrics associated with the adjudication.
• Prepare and present written and verbal s.
• Research complex problem areas within the department or within the systems used by department and identify the root cause of these issues and recommend corrective actions.
• Supervise staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others.
• Perform special
• Working with internal departments to resolve issues preventing processing or enhancing processing capabilities.
• Assist in testing, changing, analyzing and ing of specific enhancements
• Any other duties as assigned by ement.

Minimum Qualifications:

• High School diploma or GED Required.
• 4+ years processing /invoices experience preferred.
• At least 3-5 years of experience as r working with facility
• At least 2-3 years of lead/supervisory experience.
• Experienced in working with ('s).
• Must have extensive experience in handling appeals with experience in communicating with external .
• Sound understanding of care code sets including (), (), and revenue codes required.
• Familiarity with () pricing.
• Position requires the ability to multitask in a high production environment.
• Familiarity in working with and interpreting contracts
• Ability to draw conclusions from data analysis and to formulate corrective action plans when necessary.
• Proficient in using Microsoft Word and Excel.
• Must have strong coaching and mentoring skills and have the ability to build effective teams.
• Must have excellent written and verbal communication skills with ability to work effectively with diverse team members.
• Ability to research complex problems and to create clear and concise s for the handling of complex .
• Must pass a Criminal Background Screening.
• Must pass government exclusion list at time of hire and monthly thereafter.
• Familiarity with various basic PC usage.
• Able to type at least 40 wpm.
• Availability to work any day and any shift; holidays and weekends.

Accomodation: Call the Car has the right to modify the duties and functions of the job description based on the needs of the organization.