Job Description:
Assistant Claims Manager - Health Insurance
We are expanding our team to now include an Assistant Claims
Manager who is experienced with all facets of processing Health
Insurance Claims within a fast-paced environment.
In this role, you will work with and report to our Senior Claims
Manager and be responsible for assisting in the management
responsibilities of the Claims department as well as with coaching
and developing the associates.
The successful candidate will assist in ensuring operational
efficiency to achieve goals as well as provide support and guidance
to direct reports.
This is a full time, permanent role located in our Lyndhurst, NJ office.
This role can be performed in a Hybrid Fashion with working
remotely a few days per week and a few days on-site as needed.
Specific Job Responsibilities:
* Responsible for assisting in the day-to-day operations, including
supervision and productivity.
* Fill in for Senior Manager in times of absence. Make executive
decisions, hold meetings, and provide accountability.
* Assist monitoring claim inventory, cycle time processing, and
work quality to assure conformity of the organization objectives and goals.
* Effectively motivate performance and manage workflow.
* Review request for reconsiderations, complaints, and appeals.
* Assist identifying claims processing trends, large case
management, and transplant cases.
* Assist in all internal and external audits on all claim issues
and supervise processing of all billing issues.
* Participate in team meetings as well as coaching and training
sessions to ensure goals are met.
* Review claims that were referred which require investigation for
overpayment. Document the findings and determine the appropriate
course of action.
* Review and release over individual authority and high-dollar claims.
* Assist in coaching and developing associates.
* Participate in performance reviews, recruitment, and dismissal.
* Perform other related duties and projects as assigned.
Knowledge, Skills, and Abilities:
* Ability to multi-task, problem solve effectively, prioritize and follow-up.
* Able to work comfortably in a fast-paced environment.
* Exemplary interpersonal, communication and business writing skills.
* Extensive knowledge of claims processing regulations and guidelines.
* Extensive knowledge of reimbursement methodologies specific to
facility and professional claims.
* 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.
Covid-19: We ask that you are fully vaccinated prior to
joining our Team.
