Claims Manager manages the operations of an insurance claims department to meet operational, financial, and service requirements. Oversees the intake and processing of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Claims Manager manages appraisal and examination staff and processes. Assures timely and proper disposition of claims based on policy provisions. Additionally, Claims Manager recommends and implements best practices to ensure complete and thorough claim settlements, legal reviews, and investigations following company policies and insurance industry regulations. Determines the value of settlements for escalated claims. Manages negotiations of settlements and administration of claims in litigation. Typically requires a bachelor's degree. Typically reports to a director. The Claims Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. To be a Claims Manager typically requires 5 years experience in the related area as an individual contributor. 1-3 years supervisory experience may be required. Extensive knowledge of the function and department processes. (Copyright 2024 Salary.com)
Job ID: 26866
Agency: Department of Social Services / Division of Medical Services
Location: Pierre
Salary: $18.25 per hour
Pay Grade: GH
Closing Date: 05.09.2024
This is a Full-Time 40 Hour Weekly position with the Department of Social Services Division of Medical Services. For more information on the DSS, please visit https://dss.sd.gov.
Summary:
This position is responsible for assisting medical providers and recipients with their Medicaid claims. Duties include responding to calls from Medicaid providers and recipients to identify and resolve issues related to submitted claims. In addition, this position identifies and resolves errors on Medicaid claims that have been submitted.
The Ideal Candidate Will Have:
Experience in customer service position and processing medical claims.
Knowledge, Skills, Abilities:
This position is eligible for Veterans’ Preference per ARSD 55:10:02:08.
NCRC: If you possess a National Career Readiness Certificate, please submit the certificate with your application. For more information on how to acquire a National Career Readiness Certificate contact a South Dakota Department of Labor and Regulation Job Service Office. A certificate is not necessary to be considered.
The State of South Dakota does not sponsor work visas for new or existing employees. All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9. The State of South Dakota as an employer will be using E-Verify to complete employment eligibility verification upon hire.
The State of South Dakota offers employer paid health insurance plus eleven paid holidays, generous vacation and sick leave accrual, dental, vision, and other insurance options, and retirement benefits. You can view our benefits information at https://bhr.sd.gov/job-seekers/work-for-state-government/. This position is a member of Class A retirement under SDRS.
Must apply online: https://sodakprod-lm01.cloud.infor.com:1443/lmghr/xmlhttp/shorturl.do?key=PKX
You must apply online, emailed resumes or submissions will not be accepted.
South Dakota Bureau of Human Resources
Telephone: 605.773.3148 Email: careers@state.sd.us
http://bhr.sd.gov/workforus
"An Equal Opportunity Employer"
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