Claims Manager(Health Insurance TPA)
Company: People Premier
Location: Clearwater
Posted on: May 12, 2022
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Job Description:
Overview:Premier Administrative Solutions (PAS) is looking for
an experienced Claims Manager with Health Insurance and TPA (third
party administrator) experience.We are a growing and innovative
benefits management company (TPA) providing a full suite of quality
insurance products and services.Since 1994, PAS leadership has been
working side-by-side with carriers, agents, and customer service
representatives nationwide to create a dynamic, modern approach to
the marketing and administration of a variety of innovative
insurance products.Job Type: Full-TimeSalary: Starting at
$85,000Benefits: Health Insurance Dental and Vision Insurance Paid
Time Off Life Insurance Paid Holidays 401K Fun and exciting work
environment!Responsibilities:As the Claims Manager, you will be
responsible for the day-to-day management of theClaims Department,
providing strong leadership and directives that will clearly
articulatedepartment objectives and timeline expectations. You must
be proactive in foreseeingdaily workflow issues and resolving these
issues with staff and systems resulting inmeeting organization
objectives, client performance guarantees and key operationaland
quality metrics.The Claims Manager will be responsible for
management functions; expertise in theclaims management and
adjudication functionality of the CaMPS or alternative
claimsadministration platforms; managing relationships with vendors
used in the claimsadministration process; and in ensuring that PAS
meets or exceeds the claims serviceexpectations of
clients.Management Responsibilities Development and management of a
staffing plan and budget for the ClaimsDepartment. This includes
development and ongoing monitoring of standardsfor
auto-adjudication and production requirements for Claims
Departmentstaff. Monitoring of service performance metrics,
including timeliness, accuracy,compliance and satisfaction.
Interfacing with Management and Staff of clients to address
concerningtrends in claims utilization and submissions, including
higher-level serviceissues or plan interpretation.System and
Control Expertise Responsibilities Positioning as a subject matter
expert (SME) on the claims administrationfunctionality of CaMPS or
succeeding platforms as it relates to the mostefficient delivery of
claims administration services for clients. Identification of
Policies and Procedures which should be documented in theClaims
Department and working with the Enterprise Risk Management
(ERM)Department and Training Coordinator to ensure that those
Policies andProcedures are complete and appropriately updated.
Participation in the implementation and ongoing management of
vendorsselected to enhance PAS' claims service to clients and
covered individuals. Implementation and oversight of a "system of
controls" as called for in SSAE18/SOC 1/SOC 2 related to financial
and operational controls.Administrative Task Responsibility
Oversight of organizational structure designed to maintain high
levels ofefficiency and accuracy in the processing of claims.
Hiring Manager for all new team members, ensuring that experienced,
quality-oriented staff are hired for open positions with enough
lead time to ensurecontinuity of production. Development of a
comprehensive set of appropriate and reportable metricsfor managing
the Department, evaluating staff and reporting to clients. Analyze
claims workflows and processes to identify inefficiencies and
executea vision to streamline efficiencies. Detailed analysis of
audit program results to identify trends and performancemanagement
issues. Implementation of training and other initiatives toimprove
quality. Management of appropriate security measures, including
schedules ofrelease authority for staff and individual Claims
Manager responsibility forhighest dollar claims release.
Implementation of resources and procedures to review requests
forreconsideration, appeals and complaints.Review/verification of
weekly client funding requests to ensure consistencywith the Claims
Manager's expectations based on most recent
production.Qualifications:- Recent Claims experience in Healthcare
industry is a must.- Previous management experience required.- At
least 5-8 years of experience with TPA claims administration
services,including designing workflow, managing via a series of
metrics, implementingoperational controls and using quality
assurance results to design and implementquality improvement
programs.- Must be a college graduate; business or accounting
background is desired.Environmental Factors/Physical Demands:Work
is performed in an office and onsite facility care environment.
While performingthe duties of this job, the employee is regularly
required to have the ability to maintainactive customer and
employee communication; access, input and retrieve informationfrom
the computer system; enter alpha-numeric data into a computerized
system oftenwhile listening on the telephone. May be subject to
repetitive motion such as typing,data entry and vision to monitor.
May be subject to bending, reaching, kneeling,stooping and lifting
up to thirty (30) pounds.HP123
Keywords: People Premier, Clearwater , Claims Manager(Health Insurance TPA), Executive , Clearwater, Florida
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