Also referred to as: Healthcare Claims Operations Manager, Medical Claims Operations Manager
Requirements and Responsibilities

Manages healthcare claims processing operations to ensure accurate, timely, and compliant adjudication and payment of medical claims. Develops and monitors procedures, controls, and performance metrics to ensure accuracy and compliance. Reviews complex or escalated claims and provides technical guidance to processing staff. Monitors turnaround times, error rates, and backlog levels to meet departmental goals. Ensures compliance with regulatory guidelines, payer requirements, and company procedures. Requires a bachelor's degree. Typically reports to a director. Manages subordinate staff in the ...View More

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