Hunter Hamilton

Claims Manager

Location
Eden Prairie, MN
Posted
Oct 03, 2018
Closes
Nov 02, 2018
Ref
339116
Contact
Hunter Hamilton
Category
Other
Job Type
Employee
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.
Qualifications:
  • 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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