Skills & Competencies for Claims Processing Manager - Healthcare

Claims Processing Manager - Healthcare job profile

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JOB SUMMARY for Claims Processing Manager - Healthcare

Manages the administration of health insurance claims, payment processing, billing research, and responding to inquiries.

JOB RESPONSIBILITIES for Claims Processing Manager - Healthcare

Ensures timely and proper disposition of claims in accordance with coverage amounts. Trains staff on organizational policies and ensures procedures are followed at all times. Provides guidance on more complex or high-value claims.

Claims Processing Manager - Healthcare SALARY RANGE

BASE 50%
$100,760
TOTAL 50%
$108,138
Job Level
M02
Job Code
HC07000583
Education/Degree
Bachelor's Degree
Reports To
Head of a Unit/Department

Claims Processing Manager - Healthcare Skills and Competencies List

Proficiency Levels and Behavioural Indicators
Salary.com identifies five increasing levels of proficiency for each skill/competency. Some jobs require only a relatively low level of proficiency in each skill/competency, while other jobs will require a more advanced level of proficiency in the same skill/competency. These levels rate the degree of proficiency (skill level, expertise) we expect the incumbent to perform in the given skill/competency for the given job. Note that we intentionally do not associate timeframes or years of experience in performing the skill/competency because that can be misleading. Proficiency levels identify what the incumbent knows and can do rather than how long they have been doing it. Also, note that the proficiency levels are cumulative, e.g., a level 4 proficiency implies the ability to perform all the behaviors at the lower levels.
Check each Claims Processing Manager - Healthcare skill and competencie below to view definitions.
INDUSTRY COMPETENCIES CORE COMPETENCIES
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8 hard skills or competencies (industry competencies) for Claims Processing Manager - Healthcare

1 Industry Competency – Insurance Industry
Proficiency Level -3
Skill definition-Applying knowledge of the insurance industry to provide risk management services and protection to various individuals from financial loss.
Level 1 Behaviors
(General Familiarity)
Explains how reinsurance aids in meeting the long-term debts and financial obligations of a business.
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Level 2 Behaviors
(Light Experience)
Locates resources to acquire updates regarding market shifts and regulatory changes in insurance.
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Level 3 Behaviors
(Moderate Experience)
Prepares insurance plans based on client needs to minimize financial risk or losses during uncertain events.
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Level 4 Behaviors
(Extensive Experience)
Monitors industry changes to improve the strategic directions of insurance operations.
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Level 5 Behaviors
(Mastery)
Develops strategic methods for selling insurance policies to increase the profit of our organization.
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2 Industry Competency – Insurance Legal and Regulatory Environment
Proficiency Level -2
Skill definition-Creating, executing, and adhering to state and federal laws governing insurance operations to ensure financial security and consumer protection.
Level 1 Behaviors
(General Familiarity)
Describes the importance of compliance programs in maintaining an insurance legal and regulatory environment.
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Level 2 Behaviors
(Light Experience)
Documents compliance complaints to track and escalate possible legal violations and ensure prompt resolution.
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Level 3 Behaviors
(Moderate Experience)
Executes market conduct exams to verify the adherence of insurance operations to laws and regulations.
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Level 4 Behaviors
(Extensive Experience)
Reviews root causes of regulatory deficiencies to create corrective action plans and ensure adherence.
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Level 5 Behaviors
(Mastery)
Develops an insurance regulatory framework to promote consumers' protection and achieve policy objectives.
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3 Claims Processing Manager - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Manager - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Manager - Healthcare
Proficiency Level - 5

11 soft skills or competencies (core competencies) for Claims Processing Manager - Healthcare

1 Core Competencies – Standard Operating Procedures (SOP)
Proficiency Level -3
Skill definition-A set of written instructions that describes the step-by-step activities to complete tasks in compliance with business standards and industry regulations.
Level 1 Behaviors
(General Familiarity)
Discusses the considerations and concerns on applying SOP for the first time.
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Level 2 Behaviors
(Light Experience)
Gathers information on workflows and business controlling points.
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Level 3 Behaviors
(Moderate Experience)
Maintains the accuracy of SOPs to provide consistent guidance in our workplace.
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Level 4 Behaviors
(Extensive Experience)
Leverages the use of SOPs to solve business and operation problems.
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Level 5 Behaviors
(Mastery)
Keeps abreast of industry regulation and its effect on our internal SOPs.
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2 Core Competencies – Budgeting
Proficiency Level -2
Skill definition-Applying specific policies, tools and practices to plan and prepare projected revenues, expenses, cash flows, and capital expenditures.
Level 1 Behaviors
(General Familiarity)
Explains the different purposes and uses of our organization's budgets.
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Level 2 Behaviors
(Light Experience)
Produces budget reports showing planned vs. actual variances highlighted and explained.
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Level 3 Behaviors
(Moderate Experience)
Reviews and helps approve major budget adjustments to negotiate and reconcile line variances.
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Level 4 Behaviors
(Extensive Experience)
Monitors budgeting processes to ensure adherence to our organization's financial practices and standards.
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Level 5 Behaviors
(Mastery)
Establishes operating procedures to guide the consistency and repeatability of our budgeting processes.
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3 Claims Processing Manager - Healthcare - Skill and Competency
Proficiency Level - 3
4 Skill and Competency - Claims Processing Manager - Healthcare
Proficiency Level - 4
5 Competency for - Claims Processing Manager - Healthcare
Proficiency Level - 5

Summary of Claims Processing Manager - Healthcare skills and competencies

There are 8 hard skills for Claims Processing Manager - Healthcare, Insurance Industry, Insurance Legal and Regulatory Environment, Health Insurance, etc.
0 general skills for Claims Processing Manager - Healthcare.
11 soft skills for Claims Processing Manager - Healthcare, Standard Operating Procedures (SOP), Budgeting, Risk Management, etc.
While the list totals 19 distinct skills, it's important to note that not all are required to be mastered to the same degree. Some skills may only need a basic understanding, whereas others demand a higher level of expertise.
For instance, as a Claims Processing Manager - Healthcare, he or she needs to be skilled in Standard Operating Procedures (SOP), be proficient in Budgeting, and be skilled in Risk Management.

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