Senior Medical Claims Manager
(NJ or PA)
We have an immediate opening for a high-level Senior Medical Claims
Manager who has been successful with automating processes that are in
place, who is Operations driven, is familiar with Process Improvement,
building teams, building a QA Department, who is results-driven,
detailed oriented and highly experienced with a fast-moving
In this role, you will report to our Operations Director and be
responsible for managing all aspects of the Claims department.
The successful Senior Medical Claims Manager will ensure operational
efficiency to achieve goals as well as provide support and guidance to
direct reports, and build strong relationships with our clients, team
members, and other business partners.
The Senior Claims Manager position will be based out of our
headquarters located in Lyndhurst, NJ office. However, you can reside
in either the NJ or PA area, but would have to be physically in our
Lyndhurst, NJ office a few days per week. Lyndhurst, NJ is eight (8)
miles from the Bronx, NY. If you reside in PA, you can work out of
our Phila., PA location in Center City, but need to be in NJ a few
days per week.
This is a full time, permanent opportunity with a growing, innovative organization.
Specific Job Responsibilities:
• Responsible for day-to-day operations, including
supervision and productivity.
• Develop and implement workflows with actionable
components and measurable outcomes.
• Review work procedures and automated programs to detect
problem areas and opportunities for improvement.
• Monitor inventory and work queues to ensure accurate
and timely adjudication of claims.
• Initiate or assist with projects to maintain and
enhance the efficiency of claims processing.
• Proactively monitor key performance indicators and
translate that information through dashboards and reporting metrics.
• Monitor claims data for possible overpayments, billing
errors, and assist with resolving provider inquiries and appeals.
• Partner with internal and external partners to resolve
complex and escalated issues.
• Identify claims processing trends, large case
management, and transplant cases.
• Conduct frequent team meetings as well as coaching and
training sessions to ensure goals are met.
• Provide support to leadership team to optimize
workflows and develop best practices.
• Monitor benefit plan changes and new developments as
well as state regulations.
• Implement changes regarding claims and billing requirements.
• Review and release high-dollar claims.
• Support Human Resources in hiring process, performance
management, and all aspects of disciplinary actions to include, work
performance, attendance and punctuality.
• Perform other related duties and projects as assigned.
We are an Affirmative Action – Equal Opportunity Employer (Minorities
/ Females / Vets / Disabled). We 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.
COVID-19: Please note that the successful candidate
must have had at least one COVID-19 vaccination shot a minimum of two
weeks before starting their position, with the intent of getting the
second shot within your first month of employment, if they are not
already fully vaccinated, or request a medical or religious waiver. A
copy of your vaccination card must be shared upon hire. The position
would start by working, on-site, in the office at least two days/week,
with the expectation of being in the office full-time when the
pandemic situation resolves.