Claims Processing Manager jobs in the United States

Claims Processing Manager manages the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures timely and proper disposition of claims in accordance with coverage amounts. Being a Claims Processing Manager trains staff on organizational policies and ensures procedures are followed at all times. Provides guidance on more complex or high-value claims. Additionally, Claims Processing Manager typically requires a bachelor's degree. Typically reports to a head of a unit/department. The Claims Processing 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 Processing 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)

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Claims Processing Manager
  • Benecard Services, LLC
  • Clifton, NJ FULL_TIME
  • JOB SUMMARY: Claims Processing Manager/Examiner directly reports to the Senior Manager of the Claims Department and is an integral member of the Claims Leadership Team.

    ROLES AND RESPONSIBILITIES: Claims Processing Manager/Examiner will be responsible for preparing all audit document, processing claims requiring supervisory override. Distribute daily work, meeting monthly department goals, meeting prompt pay deadlines, monthly reporting and other responsibilities as assigned.

    QUALIFICATIONS:

    • 5 year experience processing and adjudicating Medicaid and Medicare claims including:
    • Billing and Coding Edits (CPT/ICD-10/HCPCS/ Modifiers)
    • Third Party Liability COB (Coordination of Benefits) filing rules.
    • CPT Codes/HCPCS Codes
    • Knowledge of AS400
    • Understanding of the billing resubmission process
    • Timely filing
    • Researching rejected claims.
    • Remittance advice
    • Proper use of modifiers with procedure codes
    • Detailed knowledge of electronic billing processes and universal billing forms (HCFA 1500)
    • Knowledge of the appeal process to government payers
    • Promptly and professionally respond to emails.
    • Computer proficiency in a Windows environment, knowledge of Microsoft Office products with an emphasis in Excel
    • Certified Professional Coder (CBC) and/or Certified Professional Biller (CPB) a plus

    Featured Benefits

    • Competitive salary
    • Potential to earn $1,000 sign-on bonus
    • Vacation and Sick/Personal Time
    • Medical Insurance
    • Hearing Program Discount
    • Short- & Long-Term Disability Insurance
    • Life Insurance
    • Flexible Spending Account
    • 401(k)
    • Employee Referral Program
    • Employee Recognition
    • Tuition Reimbursement
    • Professional Development Training

    About Benecard Services our affiliated companies:

    Benecard Services, LLC

    Benecard Services, LLC has been administering carve-out, fixed rate insured prescription drug benefit programs since 1990. Benecard is a full service, in-house prescription benefit administrator that includes mail and specialty drug dispensing. We are a premiere nationwide Prescription Benefit Administrator headquartered in Lawrenceville, New Jersey.

    Website: http://www.benecard.com

    BeneCard PBF

    BeneCard PBF provides self-funded prescription benefit program administration with a personalized approach through focused, clinical expertise. Our business model operates on a customized claim processing system offering unlimited capability and flexibility to respond to client needs in an evolving marketplace. Advanced clinical programs and advanced technology provide the framework to maximize the use of all data elements available. This allows BeneCard PBF to filter the information, focus on clinical opportunities and facilitate interaction between the physician, the pharmacist and the patient to effectively promote complete health care. Headquartered in Bonita Springs, Florida.

    Website: http://benecardpbf.com

    National Vision Administrators

    For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.

    Website: http://www.e-nva.com

    We are an Equal Opportunity employer.
  • 2 Months Ago

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Workers Compensation Claims Manager
  • TheBest Claims Solutions
  • Albuquerque, NM FULL_TIME
  • Our client, a National Insurance Company, is looking to add a Claims Manager for their direct hire opportunity. The position offers a flexible work/life structure.Requirements:7 years of Managing Work...
  • Just Posted

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Manager, Claims Processing - Covered California
  • IEHP
  • Rancho Cucamonga, CA FULL_TIME
  • What you can expect!Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!The Man...
  • 2 Days Ago

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Manager, Claims Processing - Covered California
  • Inland Empire Health Plan
  • Rancho Cucamonga, CA FULL_TIME
  • Overview What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experien...
  • 10 Days Ago

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Claims and Benefits Processing Program Manager
  • Input Technology Solutions
  • Fort Knox, KY FULL_TIME
  • Claims and Benefits Processing Program ManagerFort Knox, KYInput Technology Solutions is currently seeking a Project Manager (PM) for a potential contract to provide administrative services within the...
  • 1 Month Ago

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Word Processing Assistant 5-E7
  • FINANCIAL INSTITUTION MANAGER 14 New
  • Detroit, MI FULL_TIME
  • Salary $39,145.60 - $55,411.20 Annually Location Detroit, MI Job Type Permanent Full Time Job Number 4761-24-48-WPA-LahserProb-TF Department Corrections - Field Operations - Metropolitan Territory Ope...
  • 3 Days Ago

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Manager, Partner Success
  • Rev1 Ventures
  • Columbus, OH
  • About Rev1 Ventures Rev1 Ventures accelerates innovation with connections and capital that help entrepreneurs build high...
  • 7/26/2024 12:00:00 AM

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Oracle Order Management Lead (3weeks remote + 1 week onsite)
  • Net2Source Inc.
  • Columbus, OH
  • Net2Source Inc. is an award-winning total workforce solutions company recognized by Staffing Industry Analysts for our a...
  • 7/26/2024 12:00:00 AM

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eCommerce Operations & Process Manager (Hybrid Remote Role)
  • Reli.
  • Columbus, OH
  • Reli. is a dynamic eCommerce company experiencing rapid year-over-year growth via selling on Amazon (www.amazon.com/reli...
  • 7/25/2024 12:00:00 AM

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Project Manager
  • Cornerstone Recruiting
  • Columbus, OH
  • We are looking for a Project Manager that has a background in the general contracting construction field. The Project Ma...
  • 7/25/2024 12:00:00 AM

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Remote Commercialization Project Manager
  • Insight Global
  • Columbus, OH
  • Minimum Requirements: 7+ years of experience as a Project Manager/Commercialization Manager 3+ years of experience in co...
  • 7/25/2024 12:00:00 AM

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Project Manager
  • ACL Digital
  • New Albany, OH
  • Title: Project Manager Location: New Albany, OH Duration: 12 months Ideal candidate: Experience leading technical projec...
  • 7/25/2024 12:00:00 AM

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Seasonal: Guest Advocate (Cashier), General Merchandise, Fulfillment, Food and Beverage, Front of Store Attendant (Cart Attendant), Style, Inbound (Stocking) (T1058)
  • Target
  • Columbus, OH
  • Starting Hourly Rate / Salario por Hora Inicial: $15.50 USD per hour ALL ABOUT TARGET Working at Target means helping al...
  • 5/14/2024 12:00:00 AM

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Seasonal: Overnight Inbound (Stocking) (T1058)
  • Target
  • Columbus, OH
  • Starting Hourly Rate / Salario por Hora Inicial: $15.50 USD per hour ALL ABOUT TARGET Working at Target means helping al...
  • 5/14/2024 12:00:00 AM

Income Estimation for Claims Processing Manager jobs
$95,711 to $123,616