The primary responsibility of this position is to oversee the claims payment workflow and servicing process for programs administered by Relation Insurance claims operations. This position will supervise and monitor the claims examining department and personnel while providing direct oversight, guidance and feedback according to our claims policies, guidelines, practices and procedures. All job duties and responsibilities must be carried out in compliance with applicable legal and regulatory requirements.
• Coordinates, supervises and monitors claim activities in order to ensure an accurate, quality claim outcome while maintaining high production and performance standards.
• Schedules and prioritizes the workflow for claim examiners to ensure work is completed in a timely fashion, all deadlines are met and that claims inquiries are resolved expeditiously.
• Sets production goals for staff and monitors weekly results, providing feedback as necessary.
• Works with audit staff to identify trends and coordinates solutions to improve processes.
• Provides ongoing mentoring, training and direction to the claims service team to ensure high levels of accuracy and client service, including completing performance appraisals.
• Coordinates work and vacation schedules, including approving payroll records.
• Acts as liaison and represents the company with the utmost professionalism when working with providers, vendors and colleagues.
• Assists examiners in resolving extraordinary cases, as needed for each provider.
• Audits procedures and controls to ensure compliance with company and statutory requirements. Will provide statistical data to management to ensure adherence to company policies, procedures and state regulations.
• Assists claims service team, requiring an extensive knowledge base of company policies, practices and procedures.
• Ensures customer service standards are met.
• Performs other duties and special projects as assigned.
• Ability to lead, develop and train others.
• Excellent interpersonal, oral and written communication skills, creativity, and adaptability to changing environments.
• Ability to prioritize and handle multiple tasks in a demanding work environment.
• Ability to show initiative, good judgment, and resourcefulness.
• Exceptional customer service skills.
POSITION DESCRIPTION / 2
• Advanced skills in Microsoft Office (primarily Outlook, Excel and Word). Must be computer literate with the ability to quickly learn new and proprietary software applications.
• Working knowledge of the rules and regulations associated with HIPAA, COBRA, Health Care Reform and all other legislation and compliance related areas associated with medical coverage and plans.
• Enthusiastic, dependable, highly motivated and detail oriented.
• Hands-on, open-minded, proactive team player.
• Willingness to adhere to all principles of confidentiality.
• Self-managed and responsible for project and time management.
• Customer focused, high integrity, excellent work ethic.
• Must value operating in a collaborative work environment.
EDUCATION AND QUALIFICATIONS
• College degree in Business Administration or related field preferred or comparable work experience.
• 2+ years’ of medical claims management experience with demonstrated hands-on oversight of workflow management and staff supervision required.
• 5+ years’ medical claims processing experience, preferably working with PPO’s, fully insured and self-funded plans required.