Manager, Claim Processing

Work from home Full-time role Hiring

Job Description:

Manages day-to-day activities of team by providing strategic leadership and overseeing the operations of the claims processing team(s)
Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics
Addresses any complex or escalated claims issues to provide guidance to claim processors in handling challenging cases
Designs quality control processes to ensure the accuracy and consistency of claim processing
Assists with the development of the claim processing budget by monitoring expenses and identifying cost-saving opportunities
Analyzes claim processing data and generates reports to track and evaluate key performance metrics
Collaborates with other departments to ensure effective communication and coordination in the claim processing workflow
Ensures compliance with industry regulations and company policies

Requirements:

5–7 years of experience in healthcare claims and/or operations
5–7 years of demonstrated leadership experience, including team oversight and performance management
strong execution and delivery capabilities, including planning, implementation, and ongoing support
strong problem‑solving and sound decision‑making capabilities in complex environments
proven ability to collaborate effectively across teams and build strong partnerships with diverse stakeholders
exhibits a growth mindset, including adaptability, continuous learning, and the ability to develop self and others
strong written and verbal communication skills
Certified Billing and Coding Specialist (CBCS) preferred
Candidates located on the East Coast preferred

Benefits:

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