Medical Claims Manager

Hiring a Medical Claims Manager in the Coral Gables area. This is a full-time/in-office position. Knowledge of Medical Claims coding, different medical specialties and medical services billed for payment by providers to insurance companies is a must.
Duties & Responsibility:
Supervise the claims departments to ensure proper workflow is conducted. Monitor timelines and constantly communicate via e-mail with clients to follow up on claims handling.
Oversee Claims Examiner Department Responsible for searching the various networks and direct contracts database to determine the appropriate network that a claim should be processed through in order to secure the greatest savings to ensure clients continue to benefit from cost containment efforts.
Implement new procedures for new line of business.
Train and cross-train all staff member with the Claims Handling Process and miscellaneous.
Review & perform periodic quality assessments of work being released to the clients.
Provide clients with daily, weekly and or monthly updates on claims.
Train new staff, also cross train existing staff.
Great pay and benefits.
#1549
AppleOne is proud to be an Equal Opportunity Employer. We believe in people, and we are committed to working with people of all backgrounds and connecting them with clients and companies who share our goals of diversity and inclusiveness. All qualified applicants will receive consideration for employment without regard to race, religion, ancestry, color, national origin, age, gender identity or expression, genetic information, marital status, medical condition, disability, protected veteran status, sex (including pregnancy), sexual orientation, or any other characteristic protected by applicable federal, state, or local laws.
The Know Your Rights poster is available here:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12.pdf
The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf
For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.
AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.
https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

Founder and CEO, Janice Bryant Howroyd, is a North Carolina native who left her hometown in 1976 armed with $1500. Since then, she has dedicated her efforts to building an organization that is committed to keeping the humanity in Human Resources and Strategic, Inclusive Procurement.
Mrs. Howroyd’s commitment to excellence has grown ActOne Group to 33 countries, with over 17,000 clients and more than 2,800 employees. The largest woman-minority-owned workforce management company founded in the US, ActOne Group professionals bring expertise in delivering corporate HR initiatives to local and global markets.
Mrs. Howroyd was selected by former President Barack Obama to serve as a White House appointee and continues to serve under the current administration as an Ambassador of Energy. Mrs. Howroyd gives generously through funding and advocacy for STEM education, particularly for women and minorities.
Mrs. Howroyd leads her teams to build business success based on the ability to connect great companies with outstanding talent. Her passion for education, mentorship, and self-empowerment initiatives have earned her many professional and philanthropic recognitions. She is a sought–after speaker and media subject matter expert in her fields. Her book, The Art of Work: How to Make Work, Work for You, is available on Amazon.com.