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%
$99,751
TOTAL 50%
$107,057
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)
Describes the processes and rate standards for calculating the amount for insurance claims.
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Level 2 Behaviors
(Light Experience)
Gathers clients' financial information for the preparation of insurance contracts.
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Level 3 Behaviors
(Moderate Experience)
Performs thorough investigation and analysis of insurance claims to prevent fraudulent activities.
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Level 4 Behaviors
(Extensive Experience)
Leads the digitization and automation of insurance-related services to drive business transformation.
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Level 5 Behaviors
(Mastery)
Develops loss control practices to reduce financial exposure and risks in insurance operations.
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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)
Explains the application of insurance regulatory laws to avoid civil penalties and license suspension.
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Level 2 Behaviors
(Light Experience)
Supports the execution of a legal and regulatory framework to promote strict insurance compliance.
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Level 3 Behaviors
(Moderate Experience)
Performs compliance reviews to determine possible violations and deficiencies in insurance regulations.
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Level 4 Behaviors
(Extensive Experience)
Trains teams on new laws and regulations to reduce liability risks and compliance violations.
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Level 5 Behaviors
(Mastery)
Establishes best practices in creating insurance laws and regulations to prevent frauds and malpractices.
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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)
Lists the typical processes of SOP development.
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Level 2 Behaviors
(Light Experience)
Participates in the implementation of new SOPs and enhancement of existing ones.
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Level 3 Behaviors
(Moderate Experience)
Modifies SOPs accordingly to reflect changes in our business practices and policies.
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Level 4 Behaviors
(Extensive Experience)
Optimizes the current SOP development and implementation processes.
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Level 5 Behaviors
(Mastery)
Leads cross-functional efforts to develop and implement SOPs across our organization.
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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 importance of budget reporting and forecasting in our workplace.
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Level 2 Behaviors
(Light Experience)
Supplies supporting information and justification for major line items.
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Level 3 Behaviors
(Moderate Experience)
Utilizes software tools and applications to forecast our annual budget accurately.
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Level 4 Behaviors
(Extensive Experience)
Provides in-depth training to our entire organization about the zero based budgeting methodology.
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Level 5 Behaviors
(Mastery)
Introduces technologies, policies, and programs for more effective budget management.
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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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