Claims Processing Manager - Healthcare 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 - Healthcare 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 - Healthcare typically requires a bachelor's degree. Typically reports to a head of a unit/department. The Claims Processing Manager - Healthcare 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 - Healthcare 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.
Claims Processing Supervisor - Healthcare supervises the administration of health insurance claims, payment processing, billing research, and responding to inquiries. Ensures the accurate and timely disposition of claims and resolves matters according to coverage amounts and company procedures. Being a Claims Processing Supervisor - Healthcare provides guidance to staff on more complex or high-value claims. Reviews and resolves escalated issues. Additionally, Claims Processing Supervisor - Healthcare requires a high school diploma. Typically reports to a manager. The Claims Processing Supervisor - Healthcare supervises a small group of para-professional staff in an organization characterized by highly transactional or repetitive processes. Contributes to the development of processes and procedures. To be a Claims Processing Supervisor - Healthcare typically requires 3 years experience in the related area as an individual contributor. Thorough knowledge of functional area under supervision.
Claims Processing Director - Healthcare plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director - Healthcare develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director - Healthcare requires a bachelor's degree. Typically reports to top management. The Claims Processing Director - Healthcare manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director - Healthcare typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function.
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.
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