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Claims Manager

Company: Wipro Technologies
Location: Canfield
Posted on: January 15, 2022

Job Description:

The Claims Manager will be a Claims Team Leader with current experience in a Health Care Administration. - This Manager will oversee examiners who work on both "new day claims" as well as re-work due to adjustments. - The right candidate will play an active role in our auto-adjudication focus groups to assure any automation implemented aligns with the manual processes followed by examiners. - Oversight of SLA's for quality and turn around will be one of the primary focuses for this position as well as research/support for external and internal clients. - The Claims Manager will provide guidance to Senior Leaders regarding developing, implementing and coordinating quality and production programs to improve the quality and efficiency of our teams. Monitors the turn-around time and quality for the claims processing teams and assures resources are re-prioritized when necessary (or re-trained) to meet our existing service level agreements with our clients.Develops, implements and coordinates programs/training to improve our efficiency and performance.Provide input into the prioritization of projects within the company.Handles escalated carrier inquiries other department inquiries and complex claim issues.Responsible for direct reports including the Claims Supervisors.Provide on-going coaching and development opportunities to direct and indirect reports.Provide support training to onboard new Operational team members as needed (ad-hoc classes on claims or claims activities and not FTE training requirement).Identifies system workflow requirements to enhance team efficiency.Releases high dollar claimsInstrumental in client weekly and monthly meetings providing updates on team's progress (Candidate should be comfortable with public speaking and able to develop presentations that add value to client meetings that visually display the progress and focus of the department). - Approximately 40% of candidate's time will be spent interacting on meetings and conference calls with internal and external clients.Minimum of 3 years' experience in a role that included health care administration (preferably claims payment) or similar work experience. Experience with CPT, HCPCS, ICD-10 and standard UB coding.Excellent written and verbal communication skillsDegree preferred or equivalent job experience.

Keywords: Wipro Technologies, Canton , Claims Manager, Executive , Canfield, Ohio

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