Senior Claims Manager
We have an immediate opening for a results-driven, detailed oriented
and highly experienced Senior Claims Manager to join our team.
In this role, you will report to our Operations Director and be
responsible for managing all aspects of the Claims department.
The successful Senior 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
Lyndhurst, NJ office.
This is a full time, permanent opportunity.
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.
Knowledge, Skills, and Abilities:
* Ability to monitor performance, create reporting
metrics and take corrective action.
* Ability to multi-task, problem solve effectivity,
prioritize and follow-up.
* Able to work comfortably in a fast-paced environment.
* Exemplary interpersonal, communication and business
* Extensive knowledge of claims processing regulations
* Extensive knowledge of reimbursement methodologies
specific to facility and professional claims
* Knowledge of enrollment, eligibility, and utilization
* Possess strong work ethic.
* Proficient in Microsoft Excel, Word, and PowerPoint.
* Solid organizational skills and effective time management.
* Strong knowledge of medical terminology, ICD, CPT, CDT,
HCPCS, and Revenue coding.
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.