Assistant Claims Manager - Medical Claims

Assistant Claims Manager – Health Insurance

Phila., PA

We are expanding our team to now include an Assistant Claims Manager who is experienced with all facets of processing Health Insurance Claims and enjoys a fast-paced environment.

In this role, you will work with and report to our Senior Claims Manager and be responsible for assisting in the management responsibilities of the Claims department as well as with coaching and developing the associates.

The successful candidate will assist in ensuring operational efficiency to achieve goals as well as provide support and guidance to direct reports.

This is a full time, permanent role located in our Phila., PA office.

Specific Job Responsibilities:

· Responsible for assisting in the day-to-day operations, including supervision and productivity.

· Fill in for Senior Manager in times of absence. Make executive decisions, hold meetings, and provide accountability.

· Assist monitoring claim inventory, cycle time processing, and work quality to assure conformity of the organization objectives and goals.

· Effectively motivate performance and manage workflow.

· Review request for reconsiderations, complaints, and appeals.

· Assist identifying claims processing trends, large case management, and transplant cases.

· Assist in all internal and external audits on all claim issues and supervise processing of all billing issues.

· Participate in team meetings as well as coaching and training sessions to ensure goals are met.

· Review claims that were referred which require investigation for overpayment. Document the findings and determine the appropriate course of action.

· Review and release over individual authority and high-dollar claims.

· Assist in coaching and developing associates.

· Participate in performance reviews, recruitment, and dismissal.

· Perform other related duties and projects as assigned.

Education, Licensing and Experience Required:

· Bachelors’ degree, preferred.

· Previous claims management experience required.

· Minimum of five (5 ) years’ experience in healthcare claims processing, auditing, or quality assurance.

· Experience with WLT Software claims system is desired.

· Experience working in a Third-Party Administration (TPA) environment preferred.

Knowledge, Skills, and Abilities:

· Ability to multi-task, problem solve effectively, prioritize and follow-up.

· Able to work comfortably in a fast-paced environment.

· Exemplary interpersonal, communication and business writing skills.

· Extensive knowledge of claims processing regulations and guidelines.

· Extensive knowledge of reimbursement methodologies specific to facility and professional claims.

· Possess strong work ethic.

· Proficient in Microsoft Excel, Word, and PowerPoint.

· Solid organizational skills and effective time management.

· Strong knowledge of medical terminology, ICD, CPT, CDT, HCPCS, and Revenue coding.

This role can be performed in a Hybrid Fashion with a few days during the week as remote and the other days in our Phila., PA office.

We are an Affirmative Action – Equal Opportunity Employer (Minorities / Females / Vets / Disabled). We provide equal opportunities to all employees and applicants for employment without regard to sex, race, color, religion, marital status, national origin, age, genetic information, sexual orientation, gender (including gender identity/expression), disability, veteran status and military status, pregnancy or pregnancy-related medical conditions, or any other factor that may be protected by law.

Covid-19: We ask that you are fully vaccinated prior to joining our Team.

Job Type: Full-time

Pay: $65,000.00 - $70,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Vision insurance

Schedule:

• Monday to Friday

COVID-19 considerations:
We ask that you are fully vaccinated for Covid-19 prior to joining our team

Ability to commute/relocate:

• Philadelphia, PA 19102: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Managing Medical Claims: 3 years (Required)
• Heatlh Claims Processing: 3 years (Required)

Work Location: One location

Salary : $65,000 - $70,000