Claims Manager

Wilcox Companies is seeking an experienced Health Insurance Claims Manager to oversee the claims processing and adjudication for our health insurance division. As a Health Insurance Claims Manager, you will be responsible for ensuring that all claims are processed accurately, efficiently, and in compliance with state and federal regulations. You will also oversee a team of claims specialists and ensure that they are meeting performance goals and providing high-quality customer service to our members.

Key Responsibilities:

• Manage the daily operations of the claims department, including monitoring claims volume, managing resources, and ensuring the timely and accurate processing of all claims
• Supervise and train a team of claims specialists, ensuring they have the tools, resources, and training necessary to perform their jobs effectively
• Develop and maintain strong relationships with key stakeholders, including providers, customers, and internal departments
• Identify and implement process improvements to increase efficiency and accuracy of claims processing
• Analyze claims data to identify trends and patterns, and make recommendations for improvements to the claims process
• Ensure compliance with all state and federal regulations related to claims processing and adjudication
• Manage the claims appeals process, including reviewing appeals, making determinations, and communicating decisions to members and providers
• Collaborate with other departments, including customer service and finance, to ensure seamless operations across the organization
• Qualifications:
• Bachelor's degree in healthcare administration, business, or a related field preferred
• 5 years of experience in health insurance claims processing and management preferred
• Strong understanding of healthcare billing codes and regulations
• Experience managing a team of claims specialists
• Excellent analytical and problem-solving skills
• Strong communication and interpersonal skills
• Ability to work collaboratively with cross-functional teams
• Knowledge of claims processing software, such as Epic or Cerner, is helpful

If you are a motivated and experienced Health Insurance Claims Manager looking for a challenging and rewarding opportunity, please submit your application today. Wilcox Companies is an equal opportunity employer and welcomes applicants from all backgrounds.