Hunter Hamilton

Claims Manager

Eden Prairie, MN
Oct 03, 2018
Nov 02, 2018
Hunter Hamilton
Job Type
Employment Status
Full Time
Hunter Hamilton is seeking a Claims Manager to work in the SW metro! This is a direct hire, permanent opportunity available immediately! If you have 5+ years of management experience are looking to put your extensive medical claims and billing background to good use, please APPLY NOW!

As a Claims Manager you will oversee a team of 13 Claims Analysts, managing the full claim adjudication process.
  • Support implementation and operations of 10+ customer accounts.
  • Lead weekly operations meetings and 1:1 coaching with team members.
  • Oversee healthcare claim processing for appropriateness and completeness of information in accordance with accepted coverage guidelines, ensuring all government and state regulations are consistently met.
  • Ensures timely delivery of claims adjudication and payment to customer’s providers.
  • Work with Claims Analysts who approve, pend, or deny payment according to the accepted coverage guidelines; set up fee schedules and contracted rates in TruChart system.
  • Maintaining external and internal customer relations by interacting with staff regarding claims issues. Providing service as the key contact for clients and working as directed with customer’s providers.
  • Assist in training and onboarding new staff as needed; assist the management team in problem resolution, planning and overseeing workflows; testing and preparing documentation and updating current documentation; as well as providing suggestions and recommendations to improve workflows and departmental efficiencies.
  • Responsible for customer service call center performance for clients and third-party vendors.
  • Assists with writing and revising policies and procedures regarding claims management.
  • Minimum of a Bachelor's degree
  • 5+ years of management experience
  • Extensive knowledge with commercial, Medicare, and Medicaid insurance
  • Knowledge of UB04 and 1500 forms
  • Third part administration experience strongly preferred

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