Medical Claims Operations Manager
(Health Benefits Operations & Medical Claims Management)
Center City, Philadelphia, PA
Our Member, a full-service Health Benefits Administrator, who is
located in downtown Philadelphia, PA, is seeking a Medical Claims
Operation Manager to oversee their Claims Program.
This individual will be responsible for learning and improving the
processes of their Claims Program inclusive of medical claim auditing
and repricing program, managing staff, and managing the day-to-day
operations of the program.
The optimal candidate will have extensive knowledge of Health Benefit
Operations as well as Medical Claim Management experience. You’ll be
operating in an Assistant Director capacity.
Specific responsibilities include:
* Plan, organize, and direct day-to-day program operations
* Recommend and implement improvements to workflow,
throughput, and related processes
* Manage Claim Program staff including but not limited to productivity
* Identify training needs for staff; create, deliver, and
maintain appropriate training materials
* Coordinate with managers and staff across company
including Third Party Administrator representatives
* Monitor activities, performance, production standards
and quality of results
* Provide technical assistance to staff
* Perform other related duties as assigned?
Knowledge, Skills, and Abilities:
* Ability to both manage "in-the-weeds" and
work at a "higher level" to identify bottlenecks and other
challenges, come up with potential solutions, and institute more
efficient and accurate processes
* Strong supervisory skills, including experience
managing staff and maintaining positive culture through transitions
from manual to automatic processes, role changes, and overall change management
* Comfortable in start-up environment
* Strong technical foundation in Microsoft Office suite
and web-based applications
* Familiarity / experience with managing transition in
operations from a manual process to an automated process that requires
* Instinct to use technology, not throw more people time
* Ability to work comfortably in a fast-paced environment
* Working knowledge of provider reimbursement and payment methodologies
* Knowledge of medical terminology and coding required
* Strong written and verbal communication skills
* Excellent organizational and time management skills.
* Ability to work independently and within a team
* Skilled in Microsoft Office suite
This is a full time, permanent, direct-hire opportunity. You’ll be
working in an Assistant Director status.
The Office is located in Center City, Philadelphia, PA, conveniently
situated near SEPTA and PATCO Lines.
Our Member is an Affirmative Action - Equal Opportunity Employer
(Minorities / Females / Vets / Disabled). They provide equal
opportunities to all employees and applicants for employment without
regard to sex, race, color, religion, marital status, national origin,
age, genetic information, sexual orientation, gender (including gender
identity/expression), disability, veteran status and military status,
pregnancy or pregnancy-related medical conditions, or any other factor
that may be protected by law.