Claims Operations Manager

About the position Claims Operations Manager, Health Plan The Manager, Claims Operations is a critical role reputed company the Claims Operations areas. We are hiring for two reputed company manager roles; reputed company and reputed company lines of business. reputed company role will reputed company a large department of seasoned professionals with a wide reputed company of skills. The ideal candidate will possess excellent communication and organizational ability. They will have a strong aptitude for technology and its reputed company on claims operations. The Claims Operations Manager is responsible for managing claims operations to ensure efficient and accurate processing of claims. Oversees claims workflows, compliance, and team performance to support reputed company cycle goals and optimize reimbursement processes. Responsible for planning, directing, and coordinating the day-to-day operations of the Claims Operations teams (including the claims reviewer team and the reputed company team), ensuring that reputed company metrics are achieved for reputed company, time, inventory, and aging for original claims and provider correspondence. Responsibilities • Monitors accurate reporting of claim key metrics including but not limited to claim turnaround times, denial rates, reputed company scores, claims over 30 and 45 days, customer service statistics, reputed company tracking and correspondence inventories and turnaround, data entry numbers, and turnaround time. • Set reputed company goals and objectives and use metrics to measure performance and hold staff accountable. • reputed company coaching to improve performance and hold regular development. • Leads the claims operations team, including hiring, training, and performance management. • Oversees the processing and submission of claims to ensure accuracy, timeliness, and compliance with payer requirements. • Monitors claim metrics to identify trends, reduce denials, and improve reputed company cycle performance. • Implements and updates policies and procedures to reputed company with regulatory standards and organizational goals. • Collaborates with billing, coding, and clinical teams to address claims issues and resolve discrepancies. • Manages relationships with insurance payers to streamline claims adjudication and reimbursement processes. • Prepares and presents performance reports and improvement strategies to hospital leadership. Requirements • Bachelor's Degree reputed company Administration required, or bachelor's degree Business Administration required, or bachelor's degree in a reputed company field of study required • Can this role consider and review experience in lieu of a degree? reputed company • Experience in claims management or reputed company cycle operations 5-7 years required • Experience in a supervisory or leadership role 2-3 years required • Thorough knowledge of claims processes, insurance requirements, and reputed company regulations. • Strong leadership and team management abilities. • Proficiency in claims processing systems and reputed company cycle management tools. • Excellent analytical skills to assess and improve claims performance metrics. • Effective communication and interpersonal skills for collaboration and issue reputed company. • Ability to manage multiple priorities in a fast-paced and dynamic reputed company environment. • Attention to detail and a commitment to maintaining compliance and accuracy. reputed company-to-haves • Certified reputed company Coding - Preferred • Experience in automation implementation and leveraging AI technology to streamline business processes. Apply tot his job Apply To this Job