Claims Manager

Description

Robert Half is partnering with an established and rapidly growing company in the heart of the San Antonio market seeking to hire an experienced Claims Manager. With over 20 years of experience in the healthcare industry, this organization is dedicated to providing exceptional service, delivering high-quality healthcare solutions, and striving to positively impact the communities it serves.

The ideal candidate will have a strong background in medical claims, particularly Medicare claims, managerial experience, and a comprehensive understanding of Medicare guidelines and healthcare claims regulations. This role requires excellent leadership abilities, attention to detail, and a commitment to delivering high-quality results.

Responsibilities

• Participate in cross-departmental initiatives and contribute to budget planning.

• Manage the preparation of inbound and outbound claims submissions, including 835, 837, EFT, etc.

• Foster a positive work environment by setting clear expectations, providing coaching and feedback, and implementing corrective action plans when necessary.

• Conduct timely performance evaluations and provide constructive feedback to team members.

• Review and update departmental procedures, workflows, and resource materials to ensure efficiency and accuracy.

• Stay updated on policy and regulatory changes and implement necessary adjustments to ensure compliance.

• Develop and maintain auditing and quality control standards to uphold the integrity of claims processing.

• Supervise day-to-day operations, including workflow coordination and staff assignments, to meet productivity and quality standards.

• Manage delegated claims audit and reporting processes to ensure compliance with CMS and other regulatory requirements.

• Address escalated issues promptly and seek appropriate guidance for resolution.

• Perform other duties as assigned to support the organization's overall goals.

Requirements

Experience Requirements

• Minimum of 5 years of experience in medical claims adjudication, with at least three years in a managerial role.

• In-depth knowledge of Medicare guidelines and healthcare claims regulations.

• Experience with Delegated Medicare Advantage is essential.

• Proficiency in claims adjudication software is preferred.

• A Bachelor's Degree is preferred. Alternatively, candidates with six or more years of relevant experience will be considered in place of a degree

This organization offers competitive compensation, a benefits package, and paid time off. We encourage you to apply if you have the requisite experience and are ready to take on a challenging leadership role!

Robert Half is the world's first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit ~~~ for more information.

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